Stories about: Pain Treatment Service

Psychological interventions’ critical role in managing chronic pediatric pain

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Chronic pain is viewed as one of the most common problems in pediatrics. Current estimates suggest that approximately one in four children experiences an episode of chronic pain lasting three months or longer. Of those who experience chronic pain, 77 percent have more than one kind of pain problem.

The issue is common, but the approach for optimally managing these challenging cases is still evolving. One thing is certain, though: Because chronic pediatric pain is so complex (involving an extensive variety of factors), diagnostic testing and treatment are both extremely costly (costing more than $19 billion per year in the U.S. alone) and time consuming, taking weeks, months or in some cases even years to complete.

While thorough diagnostic testing is critical, chronic pain and pain-related disability can wreak havoc on a child’s life and exacerbate the problem even while the investigation unfolds. Arming parents and children with adaptive coping strategies to manage chronic pain — regardless of its origin — promotes better function and reduces psychological comorbidity. Psychological interventions may help change a child’s recovery trajectory by reducing pain, stress and functional disability, and may be protective if applied early in a child’s experience of pain. …Read More

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Where do opioids fit in pediatric pain management?

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The approach the field of pediatrics has taken toward pain management in children has shifted dramatically over the last half century. Pediatric pain was woefully under-managed even up to the 1970s and 80s, with infants sometimes undergoing complex surgeries without perioperative or postoperative pain control.

Over the following two decades, as physicians and scientists learned more about the acute and long-term effects of pediatric pain, the pendulum swung in favor not only of pain management, but of the use of opioid medications for controlling both chronic and acute pain in both children and adults, regardless of the pain’s origin.

“With the recognition that pain had short- and long-term potential consequences, and the lack of data at the time suggesting downsides to opioids, there was a very dramatic shift,” says Neil Schechter, MD, of the Pain Treatment Service in Boston Children’s Hospital’s Department of Anesthesia, Perioperative and Pain Medicine. “We started asking, ‘If there’s no significant downside, why should children suffer unnecessarily?'”

But has the pendulum swung too far in favor of opioids? …Read More

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