Not knowing—the problem of pain in children with severe neurological impairment

Gastroesophageal reflux and behavior in neurologically impaired children

“…Autoaggressive or agitated behavior can be an indicator for GERD in neurologically impaired children and can be considered as a marker for reoccurring or first-timediagnosed pathologic GER. This finding is consistent with that of Hunt et al [14], who identified "pains associated with alterations in gut motility such as gastro-esophageal reflux, wind and constipation" as one of the main sources of pain in children with severe neurologic impairment. This agrees with the experience of the authors that although the return of pathologic gastroesophageal reflux is marked by increased agitation or autoaggression in some patients, these symptoms tend to dissolve with antireflux medication.…”

Validation francophone de la grille d’évaluation de la douleur-déficience intellectuelle – version postopératoire

“…6 Ces douleurs, difficiles à identifier, sont peu traitées. 7 Elles ont des retentissements importants sur le potentiel d'évolution des enfants dans le domaine de la communication, des interactions sociales et des habiletés motrices. 8 Le développement, la validation et la diffusion de grilles d'évaluation adaptées à cette population constituent probablement le meilleur moyen d'améliorer la prise en charge de la douleur.…”

Chronic Pain Assessment Tools for Cerebral Palsy: A Systematic Review

“…Selfreport measures are considered to be the gold standard in pain assessment 3,46 and require an individual to reflect upon his or her unique pain experience.…”

“…3,[85][86][87] The foundation for the 20-item questionnaire stemmed from qualitative interviews with health care professionals and caregivers of children with significant neurologic impairments. 3 The clinical utility of this dual purpose scale (evaluative and discriminative) scored high within usability; however, reviewers felt the information provided would not fully capture the impact of pain on function or quality of life. Therefore, the PPP was classified as having well-established psychometric properties and moderate clinical utility for recommended use for children with GMFCS levels I to V.…”

“…1 Children with cognitive and physical impairments such as cerebral palsy (CP) are at risk for chronic pain rooted from gastrointestinal dysfunctions, musculoskeletal complications, therapeutic procedures, as well as other universal causes including trauma, infection, and common childhood pain. 2,3 CP is the most common physical disability among pediatric populations, with an incidence rate of 2 to 2.5 cases per 1000 births within the United States. 4 It is classified as a group of permanent disorders caused by nonprogressive disturbances to the developing brain.…”