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Pain in cognitively impaired children: a focus for general pediatricians

Abstract

Pain in children with cognitive impairment and cerebral palsy is a particularly relevant issue due to its high prevalence and impact on quality of life. We review available evidence about prevalence of pain, causes and specific treatment, recognition and use of specific pain scales, physiology, and consequences of pain in this subset of patients. Conclusions: Pain is very common and is a critical determinant of quality of life in children with cognitive impairment and cerebral palsy. The diseases and associated complications that frequently expose these patients to pain can be treated and pain prevented. For patients with communication difficulties, appropriate, effective, validated tools are available and should be used to diagnose pain in itself, to >choose analgesic treatment and to determine effectiveness of these therapies. The level of awareness of pediatricians towards this issue seems to be quite low.

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References

  1. 1.

    Anonymous (2002) Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 44(9):633–640

  2. 2.

    Arnaud C, White-Koning M, Michelsen SI, Parkes J, Parkinson K, Thyen U, Beckung E, Dickinson HO, Fauconnier J, Marcelli M, McManus V, Colver A (2008) Parent-reported quality of life of children with cerebral palsy in Europe. Pediatrics 121(1):54–64

  3. 3.

    Bachrach SJ, Kecskemethy HH, Harcke HT, Hossain J (2010) Decreased fracture incidence after 1 year of pamidronate treatment in children with spastic quadriplegic cerebral palsy. Dev Med Child Neurol 52(9):837–842

  4. 4.

    Barbi E, Gerarduzzi T, Marchetti F (2003) Managing chronic pain in children and adolescents: procedural sedation should be considered. BMJ 326(7404):1408–1409

  5. 5.

    Barbi E, Massaro M, Badina L (2011) Measuring pain in children with cognitive impairment and cerebral palsy: a multi-regional survey on the use of specific pain scales. Pediatr Emerg Care 27(12):1216

  6. 6.

    Bhasin TK, Brocksen S, Avchen RN, Van Naarden BK (2006) Prevalence of four developmental disabilities among children aged 8 years–Metropolitan Atlanta Developmental Disabilities Surveillance Program, 1996 and 2000. MMWR Surveill Summ 55(1):1–9

  7. 7.

    Bohmer CJ, Klinkenberg-Knol EC, Niezen-de Boer MC, Meuwissen SG (2000) Gastroesophageal reflux disease in intellectually disabled individuals: how often, how serious, how manageable? Am J Gastroenterol 95:1868–1872

  8. 8.

    Boldingh EJ, Jacobs-van der Bruggen MA, Lankhorst GJ, Bouter LM (2004) Assessing pain in patients with severe cerebral palsy: development, reliability, and validity of a pain assessment instrument for cerebral palsy. Arch Phys Med Rehabil 85(5):758–766

  9. 9.

    Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, Visser S, Kogan MD (2011) Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics 127(6):1034–1042

  10. 10.

    Breau LM, Burkitt C (2009) Assessing pain in children with intellectual disabilities. Pain Res Manag 14(2):116–120

  11. 11.

    Breau LM, Camfield CS, McGrath PJ, Finley GA (2003) The incidence of pain in children with severe cognitive impairments. Arch Pediatr Adolesc Med 157(12):1219–1226

  12. 12.

    Breau LM, Camfield CS, McGrath PJ, Finley GA (2007) Pain’s impact on adaptive functioning. J Intellect Disabil Res 51:125–134

  13. 13.

    Breau LM, Finley GA, McGrath PJ, Camfield CS (2002) Validation of the non-communicating children’s pain checklist-postoperative version. Anesthesiology 96:528–535

  14. 14.

    Breau LM, McGrath PJ, Camfield CS, Finley GA (2002) Psychometric properties of the non-communicating children’s pain checklist-revised. Pain 99(1–2):349–357

  15. 15.

    Brochard S, Blajan V, Lempereur M, Le Moine P, Peudenier S, Lefranc J, Rémy-Néris O (2009) Effectiveness of nitrous oxide and analgesic cream (lidocaine and prilocaine) for prevention of pain during intramuscular botulinum toxin injections in children. Ann Phys Rehabil Med 52(10):704–716

  16. 16.

    Bytzer P (2003) Goals of therapy and guidelines for treatment success in symptomatic gastroesophageal reflux disease patients. Am J Gastroenterol 98:S31–S39

  17. 17.

    Collignon P, Giusiano B (2001) Validation of a pain evaluation scale for patients with severe cerebral palsy. Eur J Pain 5:433–442

  18. 18.

    Costello PJ (1990) Dental health status of mentally and physically handicapped children and adults in the Galway Community Care Area of the Western Health Board. J Int Dent Assoc 36:99–101

  19. 19.

    Defrin R, Lotan M, Pick CG (2006) The evaluation of acute pain in individuals with cognitive impairment: a differential effect of the level of impairment. Pain 124(3):312–320

  20. 20.

    Dickinson HO, Parkinson KN, Ravens-Sieberer U, Schirripa G, Thyen U, Arnaud C, Beckung E, Fauconnier J, McManus V, Michelsen SI, Parkes J, Colver AF (2007) Self-reported quality of life of 8–12-year-old children with cerebral palsy: a cross-sectional European study. Lancet 369(9580):2171–2178

  21. 21.

    Fauconnier J, Dickinson HO, Beckung E, Marcelli M, McManus V, Michelsen SI, Parkes J, Parkinson KN, Thyen U, Arnaud C, Colver A (2009) Participation in life situations of 8–12 year old children with cerebral palsy: cross sectional European study. BMJ 338:b1458

  22. 22.

    Fröhlich T, Richter M, Carbon R, Barth B, Köhler H (2010) Review article: percutaneous endoscopic gastrostomy in infants and children. Aliment Pharmacol Ther 31(8):788–801

  23. 23.

    Gambart G, Mette F, Pellot AS, Richard I (2007) Evaluation of analgesic protocol with nitrous oxide and EMLA cream during botulinum toxin injections in children. Ann Readapt Med Phys 50(5):275–279

  24. 24.

    Ghai B, Makkar JK, Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment. Paediatr Anaesth 18:462–477

  25. 25.

    Hägglund G, Lauge-Pedersen H, Wagner P (2007) Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskelet Disord 8:101

  26. 26.

    Henderson RC (1997) Bone density and other possible predictors of fracture risk in children and adolescents with spastic quadriplegia. Dev Med Child Neurol 39:224–227

  27. 27.

    Henderson RC, Kairalla JA, Barrington JW, Abbas A, Stevenson RD (2005) Longitudinal changes in bone density in children and adolescents with moderate to severe cerebral palsy. J Pediatr 146:769–775

  28. 28.

    Henderson RC, Lark RK, Gurka MJ, Worley G, Fung EB, Conaway M, Stallings VA, Stevenson RD (2002) Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy. Pediatrics 110(1 Pt 1):e5

  29. 29.

    Henderson RC, Lin PP, Greene WB (1995) Bone-mineral density in children and adolescents who have spastic cerebral palsy. J Bone Joint Surg Am 77:1671–1681

  30. 30.

    Hough JP, Boyd RN, Keating JL (2010) Systematic review of interventions for low bone mineral density in children with cerebral palsy. Pediatrics 125(3):e670–e678

  31. 31.

    Houlihan CM, O’Donnell M, Conaway M, Stevenson RD (2004) Bodily pain and health-related quality of life in children with cerebral palsy. Dev Med Child Neurol 46(5):305–310

  32. 32.

    Howard CB, McKibbin B, Williams LA, Mackie I (1985) Factors affecting the incidence of hip dislocation in cerebral palsy. J Bone Joint Surg Br 67(4):530–532

  33. 33.

    Hunt A, Goldman A, Seers K, Crichton N, Mastroyannopoulou K, Moffat V, Oulton K, Brady M (2004) Clinical validation of the paediatric pain profile. Dev Med Child Neurol 46(1):9–18

  34. 34.

    Hunt A, Wisbeach A, Seers K, Goldman A, Crichton N, Perry L, Mastroyannopoulou K (2007) Development of the paediatric pain profile: role of video analysis and saliva cortisol in validating a tool to assess pain in children with severe neurological disability. J Pain Symptom Manage 33(3):276–289

  35. 35.

    Jan MM (2006) Cerebral palsy: comprehensive review and update. Ann Saudi Med 26(2):123–132

  36. 36.

    Johanson JF, Sonnenberg A, Koch TR, McCarty DJ (1992) Association of constipation with neurologic diseases. Dig Dis Sci 37(2):179–186

  37. 37.

    King W, Levin R, Schmidt R, Oestreich A, Heubi JE (2003) Prevalence of reduced bone mass in children and adults with spastic quadriplegia. Dev Med Child Neurol 45(1):12–16

  38. 38.

    Koh JL, Fanurik D, Harrison RD, Schmitz ML, Norvell D (2004) Analgesia following surgery in children with and without cognitive impairment. Pain 111(3):239–244

  39. 39.

    Krigger KW (2006) Cerebral palsy: an overview. Am Fam Physician 73(1):91–100

  40. 40.

    Lauder GR, White MC (2005) Neuropathic pain following multilevel surgery in children with cerebral palsy: a case series and review. Paediatr Anaesth 15(5):412–420

  41. 41.

    Lonstein JE, Beck K (1986) Hip dislocation and subluxation in cerebral palsy. J Pediatr Orthop 6(5):521–526

  42. 42.

    Malviya S, Voepel-Lewis T, Burke C, Merkel S, Tait AR (2006) The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Paediatr Anaesth 16(3):258–265

  43. 43.

    Malviya S, Voepel-Lewis T, Tait AR, Merkel S, Lauer A, Munro H, Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery. Paediatr Anaesth 11(4):453–458

  44. 44.

    Oberlander TF, O’Donnell ME (2001) Beliefs about pain among professionals working with children with significant neurologic impairment. Dev Med Child Neurol 43(2):138–140

  45. 45.

    Parkinson KN, Gibson L, Dickinson HO, Colver AF (2010) Pain in children with cerebral palsy: a cross-sectional multicentre European study. Acta Paediatr 99:446–451

  46. 46.

    Perquin CW, Hazebroek-Kampschreur AA, Hunfield JA, Bohnen AM, van Suijlekom-Smit LW, Passchier J, van der Wouden JC (2000) Pain in children and adolescents: a common experience. Pain 87:51–58

  47. 47.

    Pope JE, Curzon ME (1991) The dental status of cerebral palsied children. Pediatr Dent 13(3):156–162

  48. 48.

    Stallard P, Williams L, Lenton S, Velleman R (2001) Pain in cognitively impaired, non-communicating children. Arch Dis Child 85(6):460–462

  49. 49.

    Stevenson RD, Conaway M, Barrington JW, Cuthill SL, Worley G, Henderson RC (2006) Fracture rate in children with cerebral palsy. Pediatr Rehabil 9:396–403

  50. 50.

    Sullivan PB, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P (2000) Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study. Dev Med Child Neurol 42(10):674–680

  51. 51.

    Taddio A, Katz J, Ilersich AL, Koren G (1997) Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 349(9052):599–603

  52. 52.

    Taddio A, Shah V, Gilbert-MacLeod C, Katz J (2002) Conditioning and hyperalgesia in newborns exposed to repeated heel lances. JAMA 288(7):857–861

  53. 53.

    Terstegena K, de Boerd TD (2003) Measuring pain in children with cognitive impairment: pain response to surgical procedures. Pain 103:187–198

  54. 54.

    Valkenburg AJ, van Dijk M, de Klein A, van den Anker JN, Tibboel D (2010) Pain management in intellectually disabled children: assessment, treatment, and translational research. Dev Disabil Res Rev 16(3):248–257

  55. 55.

    Veugelers R, Benninga MA, Calis EA, Willemsen SP, Evenhuis H, Tibboel D, Penning C (2010) Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy. Dev Med Child Neurol 52(9):e216–e221

  56. 56.

    Voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S (2002) The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg 95(5):1224–1229

  57. 57.

    Waldman HB, Perlman SP (2002) Dental care for individuals with developmental disabilities is expensive, but needed. J Calif Dent Assoc 30(6):427–432

  58. 58.

    Zier JL, Rivard PF, Krach LE, Wendorf HR (2008) Effectiveness of sedation using nitrous oxide compared with enteral midazolam for botulinum toxin A injections in children. Dev Med Child Neurol 50(11):854–858

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Conflict of interest

We declare no conflict of interest.

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Correspondence to S. Pastore.

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Massaro, M., Pastore, S., Ventura, A. et al. Pain in cognitively impaired children: a focus for general pediatricians. Eur J Pediatr 172, 9–14 (2013). https://doi.org/10.1007/s00431-012-1720-x

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Keywords

  • Pediatrics practice
  • Pain
  • Analgesia
  • Neurodisability