Oxford Textbook of Pediatric Pain This page intentionally left blank Oxford Textbook of Pediatric Pain Edited by Patrick J. McGrath Bonnie J. Stevens Suellen M. Walker and William T. Zempsky 1 3 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the Univer sity \200\231s objective of excellence in research, scholarship, and education by publishin g worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Oxford University Press 2014 The moral rights of the authors have been asserted First Edition published in 2014 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval s ystem, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license or under terms ag reed with the appropriate reprographics rights organization. Enquiries concerning reproduct ion outside the scope of the above should be sent to the Rights Department, Oxford Universi ty Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, Ne w York, NY 10016, United States of America British Library Cataloging in Publication Data Data available Library of Congress Control Number: 2013945062 ISBN 978 \200\2230 \200\22319 \200\223964265 \200\2236 Printed in China by C&C Offset Printing Co. Ltd Oxford University press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and c linical procedures with the most up-to-date published product information and data sheets p rovided by the manufacturers and the most recent codes of conduct and safety regulations. T he authors and the publishers do not accept responsibility or legal liability for any error s in the text or for the misuse or misapplication of material in this work. Except where ot herwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding Links to third party websites are provided by Oxford in good faith and for information only . Oxford disclaims any responsibility for the materials contained in any third party websit e referenced in this work. Contents Abbreviations ix SECTION 3 Social and psychological basis of pediatric pain Contributors xi SECTION 1 Introduction 9. Psychological theories and biopsychosocial models in pediatric pain 85 Rebecca Pillai Riddell, Nicole M. Racine, Kenneth D. Craig, and Lauren Campbell 1. History of pain in children 3 Anita M. Unruh and Patrick J. McGrath 10. Cognitive styles and processes 2. Prevalence and distribution in pediatric pain 95 Liesbet Goubert and Laura E. Simons of pain in children 12 Bonnie J. Stevens and William T. Zempsky 11. Pain in cultural and 3. Long-term e \200 ects of early pain and injury: animal models 20 Suellen M. Walker communicative contexts 102 Ignasi Clemente 12. Families and pain 111 4. Long-term e \200 ects of pain in children 30 Kathryn A. Birnie, Katelynn E. Boerner, and Christine T. Chambers Ruth E. Grunau 5. Prevention of the development and maintenance of pediatric chronic pain and disability 3 9 M. Gabrielle Pag , Anna Huguet, and Joel Katz 13. Pain, social relationships, and school 119 Paula Forgeron and Sara King 14. Th e e \200 ects of sex and gender on child and adolescent pain 127 Erin C. Moon and A nita M. Unruh SECTION 2 Biological basis of pediatric pain 15. Sleep and pain in children and adolescents 135 Bruce D. Dick, Penny Corkum, Manisha Witmans, and Christine T. Chambers 6. Nociceptive signaling in the periphery and spinal cord 53 Suellen M. Walker and Mark L. Baccei SECTION 4 Pain in speci \201 c populations and diseases 7. Neuroimmune interactions and pain during postnatal development 65 David Vega-Avelaira an d Simon Beggs 16. Pain in children with intellectual or developmental disabilities 147 John L. Belew, Cha ntel C. Barney, Scott A. Schwantes, Dick Tibboel, Abraham J. Valkenburg, and Frank J. Symon s 8. Central nociceptive pathways and descending modulation 74 Maria Fitzgerald contents vi 17. Pediatric cancer pain 157 SECTION 5 Measurement of pain Jennifer Hickman, Jaya Varadarajan, and Steven J. Weisman 35. Neonatal and infant pain assessment 353 18. Pain management in major pediatric Grace Y. Lee and Bonnie J. Stevens trauma and burns 171 Greta M. Palmer and Franz E. Babl 36. Self-report: the primary source in assessment after infancy 370 Carl L. von Baeyer 19. Needle procedures 184 Anna Taddio 37. Behavioral measures of pain 379 20. Procedural sedation 194 Jill MacLaren Chorney and C. Meghan McMurtry Joseph P. Cravero 38. Biomarkers of pain: physiological indices of pain reactivity in infants and children 39 1 Susanne Brummelte, Tim F. Oberlander, and Kenneth D. Craig 21. Neuropathic pain in children 205 Suellen M. Walker 22. In \202 ammatory arthritis and arthropathy 215 Peter Chira and Laura E. Schanberg 39. Th e neurophysiological evaluation of nociceptive responses in neonates 401 Ravi Poorun and Rebeccah Slater 23. Chronic pain syndromes in childhood: one trunk, many branches 228 Neil L. Schechter 40. Sensory processing and neurophysiological evaluation in children 407 Christiane Hermann 24. Non-in \202 ammatory musculoskeletal pain 237 Jacqui Clinch 41. Measurement of health-related quality 25. Pain in sickle cell disease 248 of life and physical function 417 See Wan Th am, Anna C. Wilson, and Tonya M. Palermo Carlton Dampier and Lamia Barakat 26. Pain and gastroenterological diseases 257 Akshay Batra, Amanda Bevan, and R. Mark Beattie SECTION 6 Pharmacological interventions 27. Postoperative pain management 269 Richard F. Howard 42. Principles of pain pharmacology 28. Pain in palliative care 280 in pediatrics 429 Kim Chau and Gideon Koren Ross Drake and Ren e McCulloch 29. Recurrent abdominal pain 289 43. Th e non-steroidal anti-in \202 ammatory Jennifer Verrill Schurman, Amanda Drews Deacy, and Craig A. Friesen drugs and acetaminophen 436 Brian J. Anderson 30. Chronic pelvic pain in children 44. Developmental pharmacology of opioids 449 and adolescents 298 Susan L. Sager and Marc R. Laufer Gareth J. Hathway 45. Opioids in clinical practice 457 31. Headaches 307 Scott A. Strassels Andrew D. Hershey 46. Interventional pain management techniques for chronic pain 474 Navil F. Sethna, Pradeep Dinakar, and Karen R. Boretsky 32. Persisting pain in childhood medical illness 319 Martha Mherekumombe and John J. Collins 33. Common pain problems in the 47. Topical anesthetics and analgesics 486 outpatient setting 328 F. Ralph Berberich and Neil L. Schechter William T. Zempsky 48. Drugs for neuropathic pain 495 Sachin Rastogi and Fiona Campbell 34. E \200 ective management of children \200\231s pain and anxiety in the emergency depar tment 338 Robert M. (Bo) Kennedy contents vii 49. Sucrose and sweet taste 508 57. Occupational therapy 590 Denise Harrison, Vanessa C. Z. Anseloni, Janet Yamada, and Mariana Bueno Liisa Holsti, Catherine L. Backman, and Joyce M. Engel 58. Mother care for procedural pain in infants 600 Celeste Johnston and Marsha Campbell-Yeo SECTION 7 Psychosocial interventions SECTION 9 Special topics 50. Cognitive-behavioral interventions 519 Deirdre E. Logan, Rachael M. Coakley, and Brittany N. Barber Garcia 59. Complementary drugs \200\224herbs, vitamins, and dietary supplements for pain and symptom management 613 Joy A. Weydert 51. Operant treatment 531 Keith J. Slifer, Adrianna Amari, and Cynthia Maynard Ward 60. Complementary therapy in pediatric pain 623 52. Child life interventions in pediatric pain 543 Chantal K. LeBlanc and Christine T. Cham bers Lonnie K. Zeltzer 61. Th eory-informed approaches to translating 53. Procedural pain distraction 553 pain evidence into practice 633 Janet Yamada and Alison M. Hutchinson Lindsey L. Cohen, Laura A. Cousins, and Sarah R. Martin 54. Hypnosis and relaxation 560 62. Organizational systems in pediatric pain 642 Christina Liossi, Leora Kuttner, Chantal Wood, and Lonnie K. Zeltzer Mark Embrett and Norman Buckley 63. Education for pediatric pain 653 55. New information and communication Alison Twycross and Susan O \200\231Conner-Von technologies for pain 569 Jennifer Stinson and Lindsay Jibb 64. Th e ethics of pain control in infants and children 661 Gary A. Walco and Maureen C. Ke lley SECTION 8 Physical interventions 65. Sociodemographic disparities in pediatric pain management: relationships and predictors 669 Miriam O. Ezenwa and Anna Huguet 56. Physical therapy interventions for pain in childhood and adolescence 581 Susan M. Tuppe r, Mary S. Swiggum, Deborah O \200\231Rourke, and Michael L. Sangster Index 677 This page intentionally left blank Abbreviations ACC ACT ADR AIDS ALL ANS AOE AOM APS ART ASA BART BBB BDNF BOLD ca CAM CAMPIS CARRA anterior cingulate cortex acceptance and commitment therapy adverse drug reaction acquired immunodefi ciency syndrome acute lymphoblastic leukemia autonomic nervous system acute otit is externa acute otitis media acute pain service antiretroviral therapy American Society of Anesthesiologists biofeedback-assisted relaxation training blood \200\223brain barrier bra in-derived neurotrophic factor blood oxygen level-dependent corrected age complementary and alternative medicine Child Adult Medical Procedure Interaction Scale Childhood Arthritis a nd Rheumatology Research Alliance cognitive-behavior therapy cognitive-behavioral therapy f or insomnia contextual cognitive-behavioral therapy Crohn \200\231s disease complete Freund \200\231s adjuvant Child Facial Coding System Children \200\231s Hospital of Eastern Ontar io Pain Scale Child Health Questionnaire confi dence interval cancer-induced bone pain Cana dian Institutes of Health Research chemotherapy-induced neuropathy cytomegalovirus central nervous system carbon dioxide catecholamine-O-methyltransferase Canadian Occupational Perfo rmance Measure cyclooxygenase cerebral palsy or chronic prostatitis complex regional pain s yndrome cerebrospinal fl uid CT CTTH CYP DD DEX DIP DRG DTI E ED ECG EEG ELGA EM EMG ERP FAP fcMRI computed tomography or complementary therapy chronic tension-type headache cytochrome P450 developmental disabilities dexmedetomidine diff use idiopathic pain dorsal root ganglion di ff usion tensor imaging embryonic day emergency department electrocardiography electroencep halography extremely low gestational age erythromelalgia electromyography event-related pot ential functional abdominal pain functional connectivity magnetic resonance imaging functio nal dyspepsia Food and Drug Administration Functional Disability Inventory functional gastr ointestinal disorders Face, Legs, Activity, Cry, and Consolability scale fi bromyalgia func tional magnetic resonance imaging gestational age Guillain \200\223Barr syndrome Glasgow coma scale gastrointestinal gastro-oesophageal refl ux disease graft -versus-host disease gestational weeks hour/s human immunodefi ciency virus heel lance hypothalamic \200\223pitu itary \200\223adrenal heart rate health-related quality of life heart rate variability Inte rnational Association for the Study of Pain FD FDA FDI FGID FLACC FM fMRI GA GBS GCS GI GORD GVHD GW h HIV HL HPA HR HRQOL HRV IASP CBT CBT-I CCBT CD CFA CFCS CHEOPS CHQ CI CIBP CIHR CIN CMV CNS CO 2 COMT COPM COX CP CRPS C SF x abbreviations IBD IC ICF infl ammatory bowel disease interstitial cystitis International Classifi cation of Function ing, Disability and Health International Classifi cation Framework for Children and Youth i nformation and communication technologies intensive care unit intellectual disabilities int erferon intramuscular ionized magnesium intranasal fentanyl intranasal interventional pain management intravenous juvenile idiopathic arthritis knowledge translation local anesthesia locus coeruleus limited attentional capacity theory lidocaine-epinephrine-tetracaine lipop olysaccharide long-term potentiation mobile-health minute/s Migraine Disability Assessment multidisciplinary pain care medial prefrontal cortex magnetic resonance imaging multiple at tentional resource theory multiple sclerosis nitrous oxide N-acetylaspartate National Cente r on Complementary and Alternative Medicine National Comprehensive Cancer Network Non-commu nicating Children \200\231s Pain Checklist nasogastric National Institute for Health and Cl inical Excellence neonatal intensive care unit National Institutes of Health near-infrared spectroscopy N-methyl-D-aspartate non-nutritive sucking number needed to treat neuropathic pain numerical rating scale nociceptive specifi c non-steroidal anti-infl ammatory drug opi oid-induced hypersensitivity Ottawa Model of Research Use odds ratio Observation Scale of B ehavioral Distress postnatal day post-anesthesia care unit pain-associated disability syndr ome periaqueductal gray PARiHS Promoting Action on Research Implementation in Health Services parabrachial area Procedure Behavioral Rating Scale painful bladder syndrome patient-controlled analgesia pediatric Mig raine Disability Assessment Pediatric Quality of Life Inventory paroxysmal extreme pain dis order positron emission tomography P-glycoprotein postherpetic neuralgia pelvic infl ammato ry disease prescription monitoring program postnatal age parent/nurse-controlled analgesia peripheral nerve injury per os (orally) postural orthostatic tachycardia syndrome Pediatric Pain Center proton pump inhibitor Parents \200\231 Postoperative Pain Measure Patient Repo rted Outcomes Measurement Information System procedural sedation and analgesia physical the rapist quantitative sensory testing recurrent abdominal pain red blood cell randomized cont rolled trial rostroventral medulla primary somatosensory cortex secondary somatosensory cor tex subcutaneous sickle cell disease social communication model standard deviation superfi cial dorsal horn second/s socioeconomic status self-injurious behavior selective serotonin and noradrenaline reuptake inhibitor selective serotonin re-uptake inhibitor spinothalamic tract tricyclic antidepressant traditional Chinese medicine therapeutic drug monitoring ulc erative colitis uridine diphosphate glucuronosyltransferase visual analog scale verbal nume ric scale ventroposterolateral nucleus ventroposterior nucleus wide dynamic range World Hea lth Organization PBn PBRS PBS PCA PedMiDAS PedQL PEPD PET P-gp PHN PID PMP PNA PNCA PNI PO POTS PPC PPI PPPM PROMIS ICF-CY ICT ICU ID ifn IM IMg 2+ INF INF IPM IV JIA KT LA LC LCT LET LPS LTP m-health min MIDAS MPC mPFC MRI MRT MS N 2 O NAA NCCAM PSA PT QST RAP RBC RCT RVM S1 S2 SC SCD SCM SD SDH sec SES SIB SSNRI NCCN NCCPC NG NICE NICU NIH NIRS NMDA NNS NNT NP NRS NS NSAID OIH OMRU OR OSBD P PACU PADS PAG SSRI STT TCA TCM TDM UC UGT VAS VNS VPL VPn WDR WHO Contributors Adrianna Amari Pediatric Psychology Consultation Program, Department of Behavioral Psycholo gy, Kennedy Krieger Institute and Assistant Professor, Department of Psychiatry and Behavio ral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA F. Ralph Berberich Pediatric Medical Group, Berkeley, CA, USA Amanda Bevan Pediatric Medical Unit, Southampton General Hospital, Southampton, UK Kathryn A. Birnie Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada Brian J. Anderson Department of Anesthesia and Intensive Care, Katelynn E. Boerner Department of Psychology and Neuroscience, Starship Children \200\231s Hospital, Auckland, New Zealand Dalhousie University, Halifax, NS, Canada Vanessa C. Z. Anseloni Department of Neural and Pain Sciences Karen R. Boretsky Perioperative Regional Anesthesia Service, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children \200\231s Hospital, MA, USA University of Maryland Baltimore, MD, USA Franz E. Babl Emergency Department, Royal Children \200\231s Hospital and Murdoch Children \200\231s Research Institute, Melbourne, Australia and Associate Professor, University of M elbourne, Melbourne, Australia Susanne Brummelte Department of Psychology, Wayne State University, Detroit, MI, USA Norman Buckley Department of Anesthesia, Michael G DeGroote School of Medicine, McMaster Un iversity, Hamilton, ON, Canada Mark L. Baccei Pain Research Center, Department of Anesthesiology, University of Cincinnati, Cincinnati, OH, USA Catherine L. Backman Department of Occupational Science and Occupational Therapy, The Unive rsity of British Columbia, Vancouver, BC, Canada Mariana Bueno Department of Maternal-Child and Public Health, School of Nursing, Federal Un iversity of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil Lamia Barakat Psychosocial Services, Division of Oncology, The Children \200\231s Hospital of Philadelphia, and Associate Professor of Clinical Psychology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, PA, USA Fiona Campbell Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Univ ersity of Toronto, Toronto, ON, Canada Lauren Campbell Department of Psychology, York University, Brittany N. Barber Garcia Pain Treatment Service, Boston Toronto, ON, Canada Children \200\231s Hospital, Boston, MA, USA Marsha Campbell-Yeo Department of Pediatrics, Division of Neonatal-Perinatal Medicine, IWK Health Center and School of Nursing, Dalhousie University, Halifax, NS, Canada Chantel C. Barney Department of Educational Psychology, University of Minnesota, MN, USA Akshay Batra Department of Pediatric Gastroenterology, Child Health Division, Southampton C hildren \200\231s Hospital, Southampton, UK Christine T. Chambers Departments of Pediatrics and Psychology, Dalhousie University and Ce nter for Pediatric Pain Research, IWK Health Center, Halifax, NS, Canada R. Mark Beattie Pediatric Medical Unit, Southampton General Kim Chau Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada Hospital, Southampton, UK Simon Beggs Program in Neurosciences and Mental Health, Hospital for Sick Children and University of Toronto, ON, Canada Peter Chira Department of Pediatrics, Section of Pediatric Rheumatology, Indiana University , Riley Hospital for Children, IN, USA John L. Belew Department of Nursing and Patient Services, Gillette Children \200\231s Specialty Healthcare, St Paul, MI, USA contributors xii Jill MacLaren Chorney Departments of Anesthesia, Pain Management and Perioperative Medicine and Psychology, Dalhousie University, and IWK Health Center, Halifax, NS, Canada Liesbet Goubert Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium Ruth E. Grunau Department of Pediatrics, University of British Columbia, Developmental Neur osciences and Child Health, Child and Family Research Institute, Vancouver, BC, Canada Ignasi Clemente Department of Anthropology, Hunter College, City University of New York, NY, USA Jacqui Clinch Department of Pediatric Rheumatology, Bristol Denise Harrison Nursing Care of Children, Youth and Families, Children \200\231s Hospital o f Eastern Ontario (CHEO) and University of Ottawa, ON, Canada Royal Hospital for Children, Bristol, UK Rachael M. Coakley Departments of Anesthesia and Psychiatry, Boston Children \200\231s Hospital, Boston, MA, USA Gareth J. Hathway School of Biomedical Sciences, University of Nottingham, Nottingham, UK Lindsey L. Cohen Department of Psychology, Georgia State University, Atlanta, GA, USA Christiane Hermann Department of Clinical Psychology and Psychotherapy, Justus-Liebig Unive rsity Giessen, Giessen, Germany John J. Collins Department of Pain Medicine and Palliative Care, The Children \200\231s Hospital at Westmead, Sydney, Australia Andrew D. Hershey Neurology, Director, Headache Center, Cincinnati Children \200\231s Hospi tal Medical Center and Professor, Pediatrics and Neurology, University of Cincinnati, Colle ge of Medicine, Cincinnati, OH, USA Penny Corkum Department of Psychology and Neuroscience Dalhousie University, Halifax, NS, Canada Laura A. Cousins Department of Psychology, Georgia State University, Atlanta, GA, USA Jennifer Hickman Jane B. Pettit Pain Management Center, Children \200\231s Hospital of Wisc onsin and Assistant Professor of Anesthesiology, Medical College of Wisconsin Milwaukee, WI , USA Kenneth D. Craig Department of Psychology, University of British Columbia, Vancouver, BC, Canada Joseph P. Cravero Department of Anesthesiology, Boston Children \200\231s Hospital, Boston, MA, USA Liisa Holsti Department of Occupational Science and Occupational Therapy, University of Bri tish Columbia, Vancouver, BC, Canada Carlton Dampier AFLAC Cancer and Blood Disorders Center, Children \200\231s Healthcare of A tlanta and Department of Pediatric, Emory University School of Medicine, Atlanta, GA, USA Richard F. Howard Department of Anesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Trust, London, UK Amanda Drews Deacy Division of Developmental and Behavioral Sciences, Children \200\231s Me rcy Hospitals and Clinics, Kansas City, MO, USA Anna Huguet IWK Health Center, Halifax, NS, Canada Bruce D. Dick Departments of Anesthesiology and Pain Medicine, Psychiatry, and Pediatrics, University of Alberta, Edmonton, AB, Canada Alison M. Hutchinson School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia Lindsay Jibb Division of Hematology and Oncology, Department of Pediatrics, Hospital for Si ck Children, Toronto, ON, Canada Pradeep Dinakar Department of Anesthesiology, Perioperative and Pain Medicine and Neurology , Boston Children \200\231s Hospital and Brigham and Women \200\231s Hospital, Harvard Medi cal School, Boston, MA, USA Celeste Johnston McGill Scientist, IWK Health Center, Halifax, NS, Canada Joel Katz Department of Psychology and School of Kinesiology & Ross Drake Pediatric Palliative Care and Complex Pain Services, Starship Children \200\231s Hospital, Auckland District Health Board, Auckland, New Zealand Health Science, York University, Toronto, ON, Canada Maureen C. Kelley Department of Pediatrics, University of Washington School of Medicine, Seattle, WA USA Mark Embrett Center for Health Economics and Policy Analysis, DeGroote School of Business, McMaster University, Hamilton, ON, Canada Robert M. (Bo) Kennedy Department of Pediatrics, Division of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MI, USA Joyce M. Engel Department of Occupational Science and Sara King Mount Saint Vincent University, Halifax, NS, Canada Technology, University of Wisconsin-Milwaukee, WI, USA Gideon Koren Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children a nd University of Toronto, Toronto, ON, Canada Miriam O. Ezenwa Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, IL, USA Maria Fitzgerald Developmental Neurobiology and Scienti \201 c Director of the Pediatric P ain Research Center at UCL, London, UK Leora Kuttner Department of Pediatrics, BC Children \200\231s Hospital and University of Br itish Columbia, Vancouver, BC, Canada Marc R. Laufer Boston Children \200\231s Hospital, Gynecologist, Brigham and Women \200\231 s Hospital and Professor of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medic al School, MA, USA Paula Forgeron University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, ON, Canada Craig A. Friesen Division of Gastroenterology, Hepatology, and Nutrition, Children \200\231 s Mercy Hospitals and Clinics, Kansas City, MO, USA Chantal K. LeBlanc Child Life Services, IWK Health Center, Halifax, NS, Canada contributors xiii Grace Y. Lee Lawrence S. Bloomberg Faculty of Nursing, University Laura E. Schanberg Department of Pediatrics, Duke University of Toronto, ON, Canada Medical Center, Durham, NC, USA Christina Liossi School of Psychology, University of Southampton, Southampton, UK and Pain Control Service, Great Ormond Street Hospital for Children NHS Trust, London, UK Neil L. Schechter Chronic Pain Program, Division of Pain Medicine, Department of Anesthesio logy, Perioperative, and Pain Medicine, Boston Children \200\231s Hospital and Harvard Medi cal School, Boston, MA, USA Deirdre E. Logan Departments of Anesthesia and Psychiatry, Boston Children \200\231s Hospital, Boston, MA, USA Jennifer Verrill Schurman Division of Developmental and Behavioral Sciences, Children \200 \231s Mercy Hospitals and Clinics, Kansas City, MO, USA Sarah R. Martin Department of Psychology, Georgia State University, Atlanta, GA, USA Scott A. Schwantes Department of Pediatrics, Gillette Children \200\231s Ren e McCulloch Pediatric Palliative Care Consultant, Bayt Specialty Healthcare, Saint Paul, MN, USA Abdullah Children \200\231s Hospice, Kuwait City, State of Kuwait Navil F. Sethna Mayo Family, Pediatric Pain Rehabilitation Center, Department of Anesthesio logy, Perioperative and Pain Medicine, Boston Children \200\231s Hospital and Harvard Medic al School, Boston Children \200\231s Hospital, MA, USA Patrick J. McGrath Dalhousie University, Vise President Research, IWK Health Center and Cap ital District Health Authority, Canada C. Meghan McMurtry Department of Psychology, University of Laura E. Simons Department of Anesthesiology, Perioperative and Pain Medicine, Boston Child ren \200\231s Hospital, Boston, MA, USA Guelph, ON, Canada Martha Mherekumombe Department of Pain Medicine and Palliative Care, The Children \200\231s Hospital at Westmead, Sydney, Australia Rebeccah Slater Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK Keith J. Slifer Pediatric Psychology Consultation Program, Department of Behavioral Psychol ogy, Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD, USA Erin C. Moon Department of Psychology, British Columbia Children \200\231s Hospital, Vancouver, BC, Canada Tim F. Oberlander Complex Pain Service, BC Children \200\231s Hospital; Professor, Departme nt of Pediatrics, University of British Columbia, Vancouver, BC, Canada Bonnie J. Stevens Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Signy Hildur Eaton Chair in Pediatric Nursing Research, Senior Scientist, The Hospital for Sick Children, Toronto, ON, Canada Susan O \200\231Conner-Von School of Nursing, Center for Children with Special Health Care Needs, University of Minnesota, Minneapolis, MN, USA Jennifer Stinson Child Health Evaluative Sciences, The Hospital for Sick Children and Assis tant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, O N, Canada Deborah O \200\231Rourke Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA M. Gabrielle Pag PhD Candidate, Clinical Psychology, Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada Scott A. Strassels Department of Health Outcomes and Drugstore Practice, University of Texas at Austin, Austin, TX, USA Mary S. Swiggum Lynchburg College, Doctor of Physical Therapy Tonya M. Palermo Department of Anesthesiology and Pain Program, Lynchburg, VA, USA Medicine, University of Washington, Seattle, WA, USA Frank J. Symons Department of Educational Psychology, University Greta M. Palmer Department of Anesthesia and Pain Management, Royal Children \200\231s Hosp ital and Murdoch Children \200\231s Research Institute, Melbourne, Australia and Associate Professor, University of Melbourne, Melbourne, Australia of Minnesota, MN, USA Anna Taddio Leslie Dan Faculty of Drugstore, University of Toronto and Senior Associate Sci entist, The Hospital for Sick Children, Toronto, ON, Canada Rebecca Pillai Riddell Department of Psychology, York University, See Wan Tham Department of Anesthesiology and Pain Medicine, Toronto, ON, Canada Seattle Children \200\231s Hospital, WA, USA Ravi Poorun Wellcome Trust MBPhD Student, The London Pain Consortium, Guy \200\231s, King \200\231s College, and St. Thomas \200\231 Hospitals Medical School, King \200\231s College London and Nuf \201 eld Department of Clinical Neurosciences University of Oxford, Oxford , UK Dick Tibboel Erasmus MC, Sophia Children \200\231s Hospital, Rotterdam, the Netherlands Susan M. Tupper Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada Nicole M. Racine Department of Psychology, York University, Toronto, ON, Canada Alison Twycross Department of Children \200\231s Nursing, London South Bank University, London, UK Sachin Rastogi Department of Anesthesia and Pain Medicine, Royal Victoria In \201 rmary, Newcastle upon Tyne, UK Anita M. Unruh Faculty of Health Professions, Dalhousie Susan L. Sager Department of Anesthesiology, Perioperative and Pain Medicine, Boston Childr en \200\231s Hospital, Boston, MA, USA University, Halifax, NS, Canada Abraham J. Valkenburg Department of Pediatric Surgery, Erasmus University Medical Center-So phia Children \200\231s Hospital, Rotterdam, the Netherlands Michael L. Sangster Pediatric Complex Pain Service, IWK Health Center, Halifax, NS, Canada contributors xiv Jaya Varadarajan Jane B. Pettit Pain Management Center,Children \200\231s Hospital of Wisco nsin and Medical College of Wisconsin Milwaukee, WI, USA Joy A. Weydert Department of Pediatrics and Integrative Medicine, University of Kansas Medical Center, Kansas City, KS, USA Anna C. Wilson Institute on Development and Disability, Department of Pediatrics, Oregon He alth and Science University, Portland, OR, USA David Vega-Avelaira Departamento de Ciencias Biom dicas B sicas, Universidad Europea de Madrid, Madrid, Spain Carl L. von Baeyer University of Saskatchewan, SK, Canada Manisha Witmans Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Gary A. Walco University of Washington School of Medicine and Seattle Children \200\231s Hospital, Seattle, WA, USA Chantal Wood Pain and Palliative Center, Robert Debr University Hospital, Paris, France Suellen M. Walker Portex Unit, Pain Research and Department of Anesthesia and Pain Medicine , UCL Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Tr ust, London, UK Janet Yamada The Hospital for Sick Children, Toronto, ON, Canada Lonnie Zeltzer Pediatric Pain Program, Mattel Children \200\231s Hospital and David Geffen School of Medicine at the University of California at Los Angeles Los Angeles, CA USA Cynthia Maynard Ward Department of Behavioral Psychology, Kennedy Krieger Institute and Dep artment of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA William T. Zempsky Connecticut Children \200\231s Medical Center, University of Connecticut School of Medicine, CT, USA Steven J. Weisman Jane B. Pettit, Children \200\231s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA SECTION 1 Introduction This page intentionally left blank CHAPTER 1 History of pain in children Anita M. Unruh and Patrick J. McGrath Summary Th e problem of pain has likely concerned humankind from the beginning as pain is a compelling call for attention and a signal to escape from its source. Early eff orts to un derstand pain, and its origins, features, and treatment refl ected the duality between spir - itual conceptualizations of pain and physiological explanations depending on the predomin ance of such views in a given culture in any given historical period (McGrath and Unruh, 19 87). In the absence of physiological or behavioral explanations to explain persistent pain without obvious injury, when spiritual perspec- tives dominated, prayer, amulets, supplicat ion, and religious rites dominated approaches to pain treatment. Herbal remedies were oft e n part of such strategies and might themselves have had potent properties (Unruh, 1992, 200 7). In ancient writings about pain and disease, treatments for children were oft en given a longside discussions about the health issues of women. In this chapter, we trace early appr oaches to pain in children to the modern era high- lighting points of transition and improv ements in pediatric pain management. (Garrison, 1923; Still, 1931). Crying, restlessness, and sleeplessness were regarded as the primary symptoms of a child \200\231s pain and dis- tress (Unruh, 1992). One of the most reported pains of childhood prior to the eight- eenth and nineteenth centur ies was teething pain. Th e treatments for teething pain (Table 1.1 ) are fascinating to th e modern reader and illustrate the underlying concern with which a child-specifi c pain was regarded throughout those centuries, and the ways in which remedies were passed down and m odifi ed over time. It was not uncommon for children to die in infancy and childhood when t hey were teething though illness and death were likely due to issues other than teething (M cGrath and Unruh, 1987). Determining whether a child was in pain was a challenge and not surprisingly generally dete rmined by appeals to observation of changes in the child \200\231s behavior. Aurelianus (fi ft h century ce ) illustrates the emphasis on a child \200\231s behavior as an indicator o f pain: Th e child groans in its sleep, rolls about, gnashes its teeth, tends to lie prone, cries o ut suddenly, or falls silent, is seized with convulsions, sometimes becomes somnolent, the face becomes emaciated and loses its color; the child gets cold and answers questions with diffi culty; sometimes throws itself about with outstretched hands, working itself into per spiration. (Quoted in Garrison, 1923, p. 47) A brief early history from ancient times to the mid nineteenth century Th e earliest medica l writings about the pain and diseases of chil- dren do not provide much information about symptoms of pain and disease in children but they do illustrate an understanding that child ren could not be treated medically as if they were adults. For example, the Atharva Veda of India (1500 \200\223800 bce ) provided pediatric incantations for headache, earache, and m usculoskeletal pains (Garrison, 1923). Th e Susruta Samhita of India (second cen- tury bce ) gave dosages of drugs and herbal remedies for children separately from adults and advised administering them with milk, clarifi ed butter, or in a plaster spread on the breasts of the nurse (Garrison, 1923). Hippocrates (about 460 \200\223357 bce ), Celsus (25 bce \200 \22350 ce ), Soranus (second century CE), Galen (130 \200\223200 ce ), Oribasius (325 \200 \223403 ce ), Aurelianus (fi ft h century ce ), Aetius (sixth century ce ), and Aegineta (s eventh century ce ) all contributed to treatment of disease in infancy and childhood in the ir time period and beyond, in Greece and Rome, and in the Arab world. Th e Hippocratic writ ings of the fi ft h and fourth centuries bce described constitutional diff erences between adults and children, and gave diff erent doses of herbal remedies and means of administrati on Th ough changes in general behavior were important, crying was usually regarded as the chie f indicator of a child \200\231s pain. Some physi- cians, such as Omnibonus Ferrarius (1577 ) (an Italian physician), (Still 1931), and Starr (1895) and Holt (1897) (both American phy sicians), believed that children only cried if there was a rea- son associated with distres s. Both Starr (1895) and Holt (1897, 1908) associated diff erent features of cries with spe cifi c illnesses and severity of pain. For example, a sudden, very loud and parox- ysmal sh riek was described as hydrencephalic cry associated with headache (Starr, 1895, p. 6). Holt (1987) described acute pain as having a sharp and piercing cry that was usually accompanie d by contracting facial features and drawing up the legs and sometimes falling into an exha usted sleep. He ascribed these pains to earache and colic. Starr (1895) may have been the f i rst physician to describe facial expression of pain. He also used these features to ident ify the source of pain: Th e picture (of a healthy child) is altered by the onset of any illness, the change being in proportion to the severity of the attack. An expression of anxiety or suff ering appears , or the features become pinched and the lines are seen about the eyes and mouth. Pain most of all sets its SECTION 1 introduction 4 Table 1.1 Historical treatments of children \200\231s teething pain Source Treatments Soranus, 2nd century ce \200\230Before teething, the gums should be gently rubbed with oil or fats, and the child may be permitted to suck fat bacon without swallowing, but this should cease when the teeth appear. Th e gums should not be irritated by butter or acid substances, and if there is mu ch in \202 ammation, poulticing, and sponging are recommended \200\231 (quoted in Garrison , 1923, p. 46) Oribasious, 325 \200\223403 ce \200\230If they are in pain, smear [the gums] with dog \200\231s milk or with hare \200 \231s brain; this works also if eaten. But if a tooth is coming through with di \203 culty , smear cyperus with butter and oil-of-lilies over the part where it is erupting \200\231 ( quoted in Still, 1931, p. 38) Aetious, 6th century ce \200\230He advises the root of colocynth, hung on the child in a gold or silver case, or b rambleroot, or the tooth of a viper, especially of a male viper, set in gold, or a green ja sper suspended on the neck so as to hang down over the stomach \200\231 (quoted in Still, 1 931, p. 40) Rhazes, 859 \200\223932 ce \200\230And the treatment of it, when the gum is swollen, is that the gum should be rubbed a little with the \201 nger, and afterwards with oil and hen \200\231s fat or hare \200 \231s brain or dog \200\231s milk; and apply to the child \200\231s head water in which the re have been boiled camomile and dill, and put plasters which have a dispersing e \200 ect on his jaws; and if the pain in the part increases after this, take butter and oil of laur els, mix together and apply over the part; or take cow \200\231s butter and marrow from the thigh, and apply; and if the points of the teeth have appeared, put over the whole head an d neck clean wool, and let some tepid water be sprinkled on the wool each day \200\231 (quo ted in Still 1931, pp. 46 \200\22347) Avicenna, 980 \200\2231036 ce \200\230For burning pain in the gums apply oil and wax as an epitheme or use salted \202 esh which is a little \200\234high \200\235 \200\231 (quoted in Gruner, 1930, p. 372) Phaer, 1546 ce \200\230Th ere be divers things that are good to procure as easy breeding of teeth, among them the chiefest is to anoint the gummes with the braynes of an hare nyxte with as much ca pons grece and hony, or any of these thynges alone is exceadynge good to supple the gummes and the synewes \200 And whan the peyne is greatte and intolerable with apostema or in \202 ammacion of the gummes, it is good to make an ointment of oile of roses with the juyce of morelle otherwise called nightshade, and in lack of it annoint the jawes within with a little fresshe butter and honye \200\231 (quoted in Still, 1931, p. 121) Sainte-Marthe, 1569 ce \200\230Hare \200\231s brain, honey and red coral ring as amulet \200\231 (cited in Ruhrah , 1925) Ferrarius, 1577 ce