Schmerztherapie in der Allgemeinpädiatrie

  • B. Zernikow
  • G. Bürk
  • E. Michel


Eine Vielzahl von akuten Erkrankungen im Kindesalter geht mit Schmerzen einher. Schmerzen und Fieber sind die häufigsten Ursachen für eine ungeplante Kinderarztkonsultation. Das Hauptanliegen von Pädiater und Eltern ist die kurative Therapie der Grunderkrankung. Im Mittelpunkt des kindlichen Empfindens indes steht die Kontrolle der Leitsymptome „Schmerz und Stress“ — ihnen wird meist weniger Aufmerksamkeit geschenkt.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Anand KJS, Carr DB (1989) The neuroanatomy, neurophysiology and neurochemistry of pain, stress and analgesia in newborns and children. Pediatr Clin North Am 36: 795–822PubMedGoogle Scholar
  2. 2.
    Barr RG (1998) Colic and crying syndromes in infants. Pediatrics 102[5 Suppl E]: 1282–1286PubMedGoogle Scholar
  3. 3.
    Bertin L, Pons G, d’Athis P (1991) Randomized, double-blind, multicenter, controlled trial of ibuprofen vs. paracetamol and placebo for treatment of symptoms of tonsillitis and pharyngitis in children. J Pediatr 119: 811–814PubMedCrossRefGoogle Scholar
  4. 4.
    Bertin L, Pons G, d’Athis P, Duhamel JF, Maudelonde C, Lasfargues G, Guillot M, Marsac A, Debregeas B, Olive G (1996) A randomized, double-blind, multicentre controlled trial of ibuprofen vs. acetaminophen and placebo for symptoms of acute otitis media in children. Fundam Clin Pharmacol 10: 387–392PubMedCrossRefGoogle Scholar
  5. 5.
    Burke P, Bain J, Robinson D, Dunleavy J (1991) Acute red ear in children: controlled trial of non-antibiotic treatment in general practice. BMJ 303: 558–562PubMedCrossRefGoogle Scholar
  6. 6.
    Cederholm I, Bengtsson M, Bjorkman S, Choonarn I, Rane A (1990) Long term high dose morphine, ketamine and midazolam infusion in a child with burns. Br J Clin Pharmacol 30: 901–905PubMedCrossRefGoogle Scholar
  7. 7.
    Cortiella J, Marvin JA (1997) Management of the pediatric burn patient. Nurs Clin North Am 32: 311–329PubMedGoogle Scholar
  8. 8.
    Del Mar C, Glasziou P, Hayem M (1997) Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ 314: 1526–1529PubMedCrossRefGoogle Scholar
  9. 9.
    Eady RA (2001) Epidermolysis bullosa: scientific advances and therapeutic challenges. J Dermatol 28: 638–640PubMedGoogle Scholar
  10. 10.
    Eng CM, Guffon N, Wilcox WR et al. (2001) Safety and efficacy of recombinant human al-pha-galactosidase A — replacement therapy in Fabry’s disease. N Engl J Med 345: 9–16PubMedCrossRefGoogle Scholar
  11. 11.
    Garrison MM, Christakis DA (2000) A systematic review of treatments for infant colic. Pediatrics 106: 184–90PubMedGoogle Scholar
  12. 12.
    Gonzalez E, Pavia C, Ros J, Villaronga M, Valls C, Escola J (2001) Efficacy of low dose schedule Pamidronate infusion in children with osteo-genesis imperfecta. J Pediatr Endocrinol Metab 14: 529–533PubMedCrossRefGoogle Scholar
  13. 13.
    Gordon KE, Ludman MD, Finley GA (1995) Successful treatment of painful crises of Fabry disease with low dose morphine. Pediatr Neurol 12: 250–251PubMedCrossRefGoogle Scholar
  14. 14.
    Hayden GF, Schwartz RH (1985) Characteristics of earache in children with acute otitis media. Am J Dis Child 139: 721–723PubMedGoogle Scholar
  15. 15.
    Heger S, Maier C, Otter K, Helwig U, Suttorp M (1999) Morphin induced allodynia in a child with brain tumor. BMJ 319: 627–628PubMedCrossRefGoogle Scholar
  16. 16.
    Hoberman A, Paradise JL, Reynolds EA, Urkin J (1997) Efficacy of Auralgan for treating ear pain in children with acute otitis media. Arch Pediatr Adolesc Med 151: 675–678PubMedCrossRefGoogle Scholar
  17. 17.
    Hoffman HG, Patterson DR, Carrougher GJ, Sharar SR (2001) Effectiveness of virtual reality-based pain control with multiple treatments. Clin J Pain Sep 17: 229–235CrossRefGoogle Scholar
  18. 18.
    Iafrati NS (1986) Pain on the burn unit. J Burn Care Rehabil 7: 413–416.PubMedCrossRefGoogle Scholar
  19. 19.
    Kavanagh C (1983) A new approach to dressing change in the severely burned child and its effect on burn-related psychopatholoy. Heart Lung 12: 612–619.PubMedGoogle Scholar
  20. 20.
    Kim MK, Strait RT, Sato TT, Hennes HM (2002) A randomized clinical trial of analgesia in children with acute abdominal pain. Acad Emerg Med 9: 281–287PubMedCrossRefGoogle Scholar
  21. 21.
    Kopecky EA, Jacobson S, Hubley P, Palozzi L, Clarke HM, Koren G (2001) Safety and pharmacokinetics of EMLA in the treatment of postburn pruritus in pediatric patients: a pilot study. J Burn Care Rehabil 22: 235–242PubMedCrossRefGoogle Scholar
  22. 22.
    Lesko SM, Mitchell AA (1995) An assessment of the safety of pediatric ibuprofen. A practitioner-based randomized clinical trial. JAMA 273: 929–933PubMedCrossRefGoogle Scholar
  23. 23.
    Lucassen PL, Assendelft WJ, Gubbels JW, van Eijk JT, van Geldrop WJ, Neven AK (1998) Effectiveness of treatments for infantile colic: systematic review. BMJ 316: 1563–1569PubMedCrossRefGoogle Scholar
  24. 24.
    Lucassen PL, Assendelft WJ, van Eijk JT, Gubbels JW, Douwes AC, van Geldrop WJ (2001) Systematic review of the occurrence of infantile colic in the community. Arch Dis Child 84: 398–403PubMedCrossRefGoogle Scholar
  25. 25.
    MacDermot J, MacDermot KD (2001) Neuropathic pain in Anderson-Fabry disease: pathology and therapeutic options. Eur J Pharmacol 429: 121–125PubMedCrossRefGoogle Scholar
  26. 26.
    Mcintosh N, Smith A (1995) Thermal injury in childhood: effects on the hormonal regulation of water balance and the management of pain. In: Aynsley Green A, Ward Piatt MP, Lloyd-Thomas AR (Hrsg) Bailliere’s clinical paediatrics. International practice and research. Stress and pain in infancy and childhood. Bailliere Tindal, London 3: 547–560Google Scholar
  27. 27.
    Meyer MT, Irazuzta J, Tozibikian H (1999) Topical nitroglycerin and pain in purpura ful-minans. J Pediatr 134: 639–641PubMedCrossRefGoogle Scholar
  28. 28.
    Moore N, Ganse EV, Le Parc JM, Wall R, Schneid H, Farhan M, Verriere F, Pelen F (1999) The PAIN study: Paracetamol, Aspirin and Ibuprofen new tolerability study. Clin Drug Inverst 18: 89–98.CrossRefGoogle Scholar
  29. 29.
    Murray CS, Cohen A, Perkins T, Davidson JE, Sills JA (2000) Morbidity in reflex sympathetic dystrophy. Arch Dis Child 82: 231–233PubMedCrossRefGoogle Scholar
  30. 30.
    Nguyen DK, Agenarioti-Belanger S,Vanasse M (1999) Pain and the Guillain-Barre syndrome in children under 6 years old. J Pediatr 134: 773–776PubMedCrossRefGoogle Scholar
  31. 31.
    O’Brien JF, Meade JL, Falk JL (1993) Dexa-methason as adjuvant therapy for severe acute pharyngitis. Ann Emerg Med 22: 212–215PubMedCrossRefGoogle Scholar
  32. 32.
    Olafsdottir E, Forshei S, Fluge G, Markestad T (2001) Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child 84: 138–141PubMedCrossRefGoogle Scholar
  33. 33.
    Papadopoulos GS, Xenakis TA, Arnaoutoglou E, Tefa L, Kitsoulis PB (2001) The treatment of reflex sympathetic dystrophy in a 9 year-old boy with long standing symptoms. Minerva Anestesiol 67: 659–663PubMedGoogle Scholar
  34. 34.
    Rauch F, Schönau E, Glorieux FH (2000) Bisphosphonate. Anwendung in der Pädiatrie. Monatsschr Kinderheilk 148: 334–341CrossRefGoogle Scholar
  35. 35.
    Ries M, Wendrich K, Whybra C, Kampmann C, Gal A, Beck M (2001) Angiokeratoma and pain, but not Fabry’s disease: considerations for differential diagnosis. Contrib Nephrol 136: 256–259PubMedCrossRefGoogle Scholar
  36. 36.
    Saxe G, Stoddard F, Courtney D, Cunningham K, Chawla N, Sheridan R, King D, King L (2001) Relationship between acute morphine and the course of PTSD in children with burns. J Am Acad Child Adolesc Psychiatry 40: 915–921PubMedCrossRefGoogle Scholar
  37. 37.
    Schachter BP, Thoden WR (1993) A placebo-controlled model for assaying systemic analgesics in children. Clin Pharmacol Ther 53: 593–601CrossRefGoogle Scholar
  38. 38.
    Schiffmann R, Kopp JB, Austin HA 3rd et al. (2001) Enzyme replacement therapy in fabry disease: a randomized controlled trial. JAMA 285: 2743–2749PubMedCrossRefGoogle Scholar
  39. 39.
    Sharar SR, Bratton SL, Carrougher GJ et al. (1998) A comparison of oral transmucosal fen-tanyl citrate and oral hydromorphone for inpatient pediatric burn wound care analgesia. J Burn Care Rehabil 19: 516–521PubMedCrossRefGoogle Scholar
  40. 40.
    Shaw NJ, Boivin CM, Crabtree NJ (2000) Intravenous Pamidronate in juvenile osteoporosis. Arch Dis Child 83: 143–145PubMedCrossRefGoogle Scholar
  41. 41.
    Sheridan R, Stoddard F, Querzoli E (2001) Management of background pain and anxiety in critically burned children requiring protracted mechanical ventilation. J Burn Care Rehabil 22: 150–153PubMedCrossRefGoogle Scholar
  42. 42.
    Sherry DD, Wallace CA, Kelley C, Kidder M, Sapp L (1999) Short- and long-term outcomes of children with complex regional pain syndrome type I treated with exercise therapy. Clin J Pain 15: 218–223PubMedCrossRefGoogle Scholar
  43. 43.
    Teele DM, Klein JO, Rosner B (1983) Middle ear disease and the practice of pediatrics. Burden during the first 5 years of life. JAMA 249: 1026–1029PubMedCrossRefGoogle Scholar
  44. 44.
    Van Buchern FL, Peeters MF, van’t Hof MA (1985) Acute otitis media: a new treatment strategy. BMJ 290: 1033–1037CrossRefGoogle Scholar
  45. 45.
    Veltri JC, Douglas ER (1988) A comparison of the frequency and severity of poisoning cases for ingestion of acetaminophen, aspirin, and ibuprofen. Am J Emerg Med 6: 104–107PubMedCrossRefGoogle Scholar
  46. 46.
    Wade S, Kilgour T (2001) Extracts from „clinical evidence“: Infantile colic. BMJ 323: 437–440PubMedCrossRefGoogle Scholar
  47. 47.
    Weisman SJ, Bernstein B, Schechter NL (1998) Consequence of inadequate analgesia during painful procedures in children. Arch Pediatr Adolesc Med 152: 147–149PubMedCrossRefGoogle Scholar
  48. 48.
    Wessel M, Cobb J, Jackson E, Harris G, Detwiler A (1955) Paroxysmal fussing in infancy, sometimes called „colic“. Pediatrics 14: 421–435Google Scholar
  49. 49.
    Wheeler DS, Vaux KK, Tarn DA (2000) Use of gabapentin in the treatment of childhood reflex sympathetic dystrophy. Pediatr Neurol 22: 220–221PubMedCrossRefGoogle Scholar
  50. 50.
    Wiberg JM, Nordsteen J, Nilsson N (1999) The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipul Physiol Ther 22: 517–522CrossRefGoogle Scholar
  51. 51.
    Wilder RT (1996) Reflex sympathetic dystrophy in children and adolescents: differences from adults. In: Jänig W, Stanton-Hicks M (Hrsg) Reflex sympathetic dystrophy: a reappraisal. Progress in pain research and management, vol 6. IASP-Press, Seattle, S 67–79Google Scholar
  52. 52.
    Williams J, Watkins-Jones R (1984) Dicyclomine: worrying symptoms associated with its use in some small babies. Br Med J (Clin Res Ed) 24: 901CrossRefGoogle Scholar
  53. 53.
    Wilson JT, Brown RD, Kearns GL, Eichler VF, Johnson VA, Bertrand KM, Lowe BA (1991) Single-dose, placebo-controlled comparative study of ibuprofen and acetamoniphen an-tipyresis in children. J Pediatr 119: 803–811PubMedCrossRefGoogle Scholar
  54. 54.
    Woldman S (1998) Treating ear pain in children with acute otitis media. Arch Pediatr Adolesc Med 152: 102PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • B. Zernikow
  • G. Bürk
  • E. Michel

There are no affiliations available

Personalised recommendations