The assessment and management of pain in children with Guillain-Barré Syndrome in a sub-Saharan setting.

Abstract

Introduction: Neuropathic pain is challenging to manage in children compounded by inappropriate assessment tools. The lack of evidence-based pain control guidelines for children results in clinicians deferring to expert opinion and personal preference. Children with Guillain-Barré Syndrome are particularly at risk is of neuropathic pain. Objectives and Methods: This is a retrospective study of children with Guillain-Barré Syndrome who were admitted to Red Cross War Memorial Children's Hospital, Cape Town, South Africa over a 10 year period. The study reviewed their pain assessment and management practice. Results: Eighty-four children were identified with Guillain-Barré Syndrome. 76% had symptoms of pain and 53% had breakthrough pain reported. Standardised pain rating scales were used in 3 patients. A mean of 2.7 analgesics were used per patient. Carbamazepine and gabapentin, were utilised in 27 and 20 patients respectively. The use of gabapentin increased 73% per annum from 2009. There was no statistical difference between these two groups for length of hospital stay or long-term disability. Conclusion: This study identified a significant gap in the assessment of pain in children with Guillain-Barré Syndrome. Tools to adequately assess pain are needed, especially in immobile and non-verbal children. Management of pain revealed a high use of adjuvant drugs. The dramatic increase in the use of gabapentin related to clinician preference and was not supported by any evidence. Clinical outcomes for both the carbamazepine and the gabapentin group were no different.