Paediatric & neonatal pain最新文献

Good communication strategies are essential in the management of chronic pain in children. While physiotherapists play a key role in pain management, there is limited guidance on adapting communication strategies for children of different ages. This study describes the communication approaches physiotherapists consider when working with children experiencing chronic lower limb pain and how they adapt these strategies across developmental stages. This study incorporated a qualitative design with three case vignettes and semi-structured focus groups with 20 physiotherapists with experience in pediatrics (mean 11 years physiotherapy experience, 70% with 80%-100% pediatric caseload). Data were analyzed using thematic analysis. Three key themes were generated: (1) Understanding the child and their needs, tailored to the child's developmental level, interests, and communication style; (2) Reassuring and empowering the child, highlighting strategies to build trust, validate pain experiences, and foster autonomy; and (3) Educating the child and their family, addressing pain-related misconceptions and supporting pain management. Additionally, four communication strategies were described by physiotherapists as methods they employ during consultations to support their approaches. These were (1) visual aids, (2) mirror child's language, (3) storytelling and analogies, and (4) age-appropriate resources. Physiotherapists describe understanding, empowering, and educating children with chronic pain through diverse communication strategies tailored to the child's age. These findings highlight the different approaches that may be helpful for physiotherapists who are new to pediatrics or chronic pain management and may enhance physiotherapy practice and improve outcomes for children with chronic pain.

Chronic pain in children and adolescents is widespread and negatively affects school attendance and developmental trajectories. Teachers are central to how pain (both acute and chronic) is experienced by their students because of their position as educators and social role models. Therefore, we aimed to explore how teachers make meaning from and respond to their students' pain, and identify individual and system-level strengths to guide recommendations for clinical and public health interventions for pain management in schools. We conducted a qualitative study using semi-structured individual interviews with schoolteachers using an Appreciative Inquiry approach. We analyzed our results using reflexive thematic analysis, with inductive and deductive approaches. Our analysis was based on a socio-ecological framework. We interviewed 11 teachers working in primary (n = 8), secondary schools (n = 2) and leadership (n = 1). We generated three themes to capture participant experiences: (1) The teacher-student relationship: teachers are dedicated to building a connection and have key teaching and learning skills that can support pain; (2) the school community: inclusion policy and culture can positively influence pain outcomes; and (3) societal influences: misconceptions about pain can influence how teachers perceive the reality of pain. This research enhances our comprehension of the ways in which student pain (whether acute or chronic) is experienced and responded to within the school environment. The insights gained can enrich clinical perspectives and foster collaborative efforts with educators to mitigate the adverse impacts of chronic pain on young individuals, such as increased school absenteeism and pain-related stigma.

Bibliometric reviews explore patterns in publications in a given research area by exploring trends over time and the contributions by citations, such as relationships between authors and publications. Despite "chronic pain" being the second most common keyword in pain research, no bibliometric reviews have focused on publication trends related to the prevalence of chronic pain in children and adolescents. A bibliometric analysis was conducted with articles included in a systematic review and meta-analysis on the prevalence of pediatric chronic pain to identify the recent trajectory of the field and guide future directions. Publication bibliometrics data from the articles were extracted and analyzed (e.g., gender of authors, citation counts, and countries) and was visualized in VOSViewer. Among 119 studies, the number of publications per year ranged from 4 (2023) to 11 (2014, 2021) with an average of 8/year. Articles were cited on average 36.6 times (SD = 51.7, range 0-380) with 5058 unique citations. There were 74 different journals represented, with most publishing only 1 article (n = 52, 70%). Seventy countries were represented in prevalence data, 78% from high-income countries; fifteen (21.4%) had only one data point, primarily from low- and lower-middle income countries. There were 109 different corresponding authors, with only 1 corresponding author who had more than 2 published articles. There was relative gender equity in terms of first and corresponding author. There was little to no collaboration between author groups identified. Despite a steady number of articles published over the 14-year period, the literature on the prevalence of pediatric chronic pain appears fragmented with articles published in a wide variety of journals. Prevalence data from low- and lower-middle-income countries were under-represented. Future work should focus on expanding evidence in underrepresented areas and greater collaboration among research groups to collect prevalence data in geographical areas where data gaps exist.

The assessment of acute non-procedural pain in term neonates in maternity wards is challenging due to the difficulty in selecting an appropriate scale and the time-consuming nature of the process. This can lead to inadequate neonatal pain management. To validate the EValuation ENfant DOuLeur (EVENDOL) pain scale for acute non-procedural pain in term neonates in maternity units by comparing it with the Echelle Douleur et Inconfort du Nouveau-né (EDIN) used as a reference. We hypothesized that EVENDOL would be equivalent to EDIN in assessing acute non-procedural neonatal pain, with better appearance. Prospective multicentric non-interventional open study. Term neonates over 37 weeks' gestation in the delivery room and postnatal care units, with or without acute non-procedural pain, before and after analgesia. Cronbach's α coefficient, intraclass correlation (ICC), and correlation between EVENDOL and EDIN scores, documented by the researchers and the caregivers at rest and mobilization, before and after oral paracetamol, were measured. Ninety-one neonates were included: 48 (51%) had pain and 43 (47%) had no pain. Before analgesia, the Cronbach coefficient was above 0.80, the ICC (25th-75th interquartile ranges [IQ]) were 0.84 (0.77-0.89) and 0.90 (0.85-0.93) at rest and mobilization, respectively. Seventeen patients received oral acetaminophen and were re-assessed. Psychometric values remained good after analgesia (Cronbach coefficient above 0.80, ICC [IQ]: 0.65 [0.26-0.85] and 0.76 [0.45-0.91]) at rest and mobilization, respectively. The feasibility and ease of use were better for EVENDOL for researchers and caregivers. EVENDOL is suitable for the assessment of acute non-procedural neonatal pain for term neonates in the maternity wards. Trial Registration: ClinicalTrials.gov identifier: NCT02819076, registered in June 2016 as EVENDOL scale validation for at term newborn.

Chest pain is a common complaint among children that has a non-cardiac origin in 99% of pediatric cases. We conducted a literature review of the different proposed etiologies of pediatric chest pain, as well as the evidence base supporting current approaches. Among the non-cardiac causes of chest pain in children, musculoskeletal causes are reported to be the most prevalent. This includes precordial catch syndrome, Tietze's syndrome, and costochondritis. However, these origins of musculoskeletal chest pain were described historically, and their labels are likely applied too broadly. It is important that providers be able to differentiate between benign chest pain that truly has a musculoskeletal origin and that which lacks an identifiable cause. To determine the cause of chest pain, providers should take a detailed history, physical examination, electrocardiogram, and any additional indicated laboratory tests. Musculoskeletal chest pain should only be diagnosed if there is an objective finding of reproducible tenderness during the physical examination or if there is a plausible history. If no cause can be identified, the chest pain may be linked to somatization. As a result, these patients may benefit from psychiatric evaluation and mindfulness-based interventions. To better inform clinical care, providers should be aware of these emerging management approaches.

Observer-dependent infant pain scales have limitations including discontinuous assessments and the lack of healthcare professionals' availability. We hypothesized that applying agnostic machine learning approaches to neonatal electroencephalographic (EEG) analysis may reveal features of the infant response to acute pain. EEG was recorded from 30 neonates undergoing acutely painful procedures (18 males, 34.0-41.7 weeks gestation at birth). EEG recordings were randomly assigned to training (n = 20) and testing (n = 10) datasets. Functional connectivity measures were calculated for each infant before and after pain-inducing procedures. A grid search including five machine learning models was conducted on the training dataset, and each model was evaluated using leave-one-subject-out cross-validation. An optimal model, having the highest F-1 score, was obtained and evaluated on the independent testing dataset. A gradient boosting model with 12 features showed optimal performance, with 90% area under the receiver operating characteristic curve suggesting high specificity (0.90) and precision (0.90). The five highest ranked features corresponded to EEG electrode pairs: T7-P4, Fz-CP5, FC1-TP10, CP6-Cz, and Fz-F3, suggesting involvement of the contralateral temporal gyrus, opercular cortex, thalamus, and bilateral insula in infant pain processing. Preliminary changes in functional connectivity indicate infant pain processing. Future machine learning algorithms can integrate physiological and behavioral parameters with EEG changes to accurately assess the complexity of infant pain responses. Trial Registration: ClinicalTrials.gov identifier: NCT03330496.

Compared to the adult literature, there are few enhanced recovery after surgery (ERAS) protocols standardized in the pediatric population. The objective of the current study is to determine if the implementation of an ERAS protocol would improve patient outcomes in the ambulatory pediatric urologic population. A retrospective analysis was performed on pediatric patients who underwent urologic procedures (circumcision, orchiopexy, hypospadias correction, and urethroplasty) in the ambulatory surgical setting affiliated with a tertiary pediatric hospital. Outcomes measured include opioid use, home pain control, time in recovery, need for rescue pain medications, and adverse events between pediatric patients receiving standard of care (n = 30) and pediatric patients receiving the ERAS protocol (n = 29). The application of the ERAS pathway led to significantly increased opioid-free care (7% vs. 43%, p < 0.01). There was a reduction in the cost of care, a trend toward reduced opioid use, a trend toward reduced PACU stays for ERAS patients, and families of ERAS patients reported a 100% rate of well-controlled pain at home. These changes occurred without any increased need for rescue pain medications (16% vs. 13%, p = 1) or any change in adverse events (0% vs. 0%, p = 1.0). Postoperative pain measures are improved in pediatric patients receiving the ERAS protocol in an ambulatory surgery setting when compared to patients receiving the standard of care, without an increased risk of adverse events or the need for rescue analgesia. Therefore, this work serves as a proof of concept that ERAS protocols can improve postoperative outcomes in the pediatric ambulatory surgical population.

Children who are hospitalized may sometimes not be able to communicate verbally to self-report their pain or other symptoms due to medical conditions, medical interventions, or communication difficulties. As such, these children may need other means, such as augmentative and alternative communication (AAC) strategies, in this case, graphic symbols, to express their pain-related experiences and receive applicable treatment. Choosing suitable graphic symbols to represent pain-related words contributes to the effective use and implementation of visual support. This study explored the preferences of 6.0-9.11-year-old (years; months) children with typical development regarding graphic symbols to represent pain-related words. These symbols were selected from two commonly used and widespread symbol resources: Picture Communication Symbols (PCS®) and Aragonese Portal of Augmentative and Alternative Communication (ARASAAC) symbols. A descriptive, quantitative study design was employed, including a total of 30 typically developed South African children. Data were collected by means of an electronic questionnaire and analyzed using descriptive and inferential statistics. Probability values were determined and predictions, as well as inferences, were implemented. The results showed that the children preferred ARASAAC symbols to represent most pain-related words (p < 0.001). It is important to consider stakeholders' (in this case, children's) input on their preferences in designing communication support to enable participation during the clinical decision-making process.

The opioid crisis has emphasized identification of opioid-sparing analgesics. This study was designed as a prospective trial with retrospective control group to determine feasibility for implementing a high-dose prolonged magnesium sulfate infusion for adjuvant analgesia in the pediatric intensive care unit. Approval was granted for study of children receiving total pancreatectomy with islet cell autotransplantation and liver transplantation ages 3-18 years. Study exclusions were pregnancy, neuromuscular disease, hypersensitivity, preoperative creatinine >1.5 times upper limit normal, arrhythmia or pacemaker presence, and clinician concern. Eleven patients were enrolled between January 2020 and December 2022. Magnesium sulfate bolus (50 mg/kg) followed by intravenous infusion (15 mg/kg/h) was initiated in the operating room and extended postoperatively (maximum 48 h). Serum magnesium levels were monitored serially. To prioritize safety, infusion dose was decreased by 5 mg/kg/h for levels greater than 3.5 mg/dL. Clinical team otherwise followed standard multimodal pain practice. Primary outcome was oral morphine equivalent per kg per day during intensive care course (maximum 7 days). Secondary outcomes focused primarily on magnesium safety, including hemodynamic variables, electrolyte variables, respiratory support, and opioid-related side effects. There were no serious adverse events. Treatment group trended toward slightly higher intravenous fluid requirement (~1 bolus), however no increase in blood product. Treatment and control groups were otherwise comparable in targeted outcomes and overall adverse event profile. Use of a high-dose magnesium sulfate infusion protocol for analgesic postoperative use in select transplant recipients appears feasible for continued optimization of study in the PICU.