A Clinical Profile of a Cohort of Patients Referred to an Anesthesiology-Based Pediatric Chronic Pain Medicine Program

Abstract

Pediatric chronic pain patients previously under the care of another subspecialist and subsequently referred to an anesthesiology-based pediatric chronic pain medicine program seemed to be experiencing significantly worse health-related quality of life. The routine assessment of chronic pain-related pediatric health-related quality of life seems feasible and worthwhile. Attention also needs to be focused on consistently addressing the strength of a patient's coping mechanisms, the presence of pain-promoting versus pain-reducing parental behaviors, and preexisting parental pain and disability.

Inpatient Characteristics of the Child Admitted With Chronic Pain

“…The findings in our study are generally consistent with those of previously published outpatient studies, which largely agree that the typical chronic pain patient is an adolescent female between 11 and 15 years old with headaches, recurrent abdominal and musculoskeletal pains, as well as depression and anxiety, suggesting that the inpatient chronic pain population is similar to their outpatient cohorts. 6,16,26,27,29,30 This is the only study, however, which demonstrates a relatively high degree of adverse medication effects, likely owing to the types of treatments received. In addition, substance abuse and overdose occurred not infrequently in this cohort and many of the treatments these patients receive, such as opiates, have the potential for abuse and addiction.…”

The Role of Peripheral Nerve Blocks in the Interdisciplinary Care of Children with Chronic Pain: A Case Series and Review of the Literature

“…While it is difficult to interpret the causal relationship underpinning this association with confidence, it is likely that causation runs in both directions: a child's chronic pain has an adverse effect on family life; family problems make it more difficult for the child to cope and so worsen the experience of pain. The impact of chronic pain on the family matches the adverse impact experienced by families caring for children at home with severe cerebral palsy or birth defects (Vetter, 2008). Daily care arrangements for the child/adolescent with chronic pain require additional support, which may cost money or require a parent to give up a job.…”

“…One such measurement instrument is the Pediatric Quality of Life Inventory (PedsQL), which contains items relating specifically to both physical and psychosocial function (the latter comprising emotional, social and school function) and can be completed by self-report or parent-proxy (Varni et al, 2001). Using this instrument, a US study of 100 patients, aged 2-21 years, attending a chronic pain clinic found that the HRQoL scores of these patients were not only considerably lower than scores obtained from normal healthy children, but were significantly lower than scores observed in children with rheumatological or cancer disease (Vetter, 2008). Another US study found that the mean PedsQL score for a cohort of 69 children and adolescents (aged 8 -18 years) seeking outpatient pain management services, fell below the 'at-risk cut-off score' for all dimensions except social functioning, suggesting that the majority of these children were experiencing significant disruption in their day-to-day lives.…”

“…School functioning has received perhaps the most attention (Palermo, 2000). It demonstrates the most marked detriment of all the psychosocial dimensions of the PedsQL scale (Vetter, 2008;Gold et al, 2009) and clearly illustrates the complex effects of chronic pain on quality of life. A child with chronic pain may experience a range of problems which impact on their schooling: fatigue and/or poor sleep profile prevents early morning waking; pain inhibits physical ability to get to school, to sit in a classroom for long periods or to participate in physical activities; fear of pain by accidentally being knocked during recess times inhibits social interaction and imparts a sense of isolation, difference and not being involved with peers; poor memory and concentration affects schoolwork; as school work becomes missed or incomplete these unfinished projects become a barrier to return to school if workload is not controlled; and the school may represent an environment where their pain condition is not properly understood or tolerated.…”

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

“…As chronic pain persists, the child can experience increased pain intensity, distress, sadness, anxiety, depression resulting in very poor quality of life [241]. The impact of chronic pain on the family matches the adverse impact experienced by families caring for children at home with severe cerebral palsy or birth defects [242][243][244]. Direct and indirect costs such as loss of earnings, adaptations to housing, over-thecounter medications and care assistance managing a child with chronic pain are considerable [245][246][247][248].…”