Bringing Pain Relief to Children (2006)

Bringing Pain Relief to Children Finley GA, McGrath PJ, Chambers CT, eds. Totowa, NJ: Humana Press, 2006. ISBN 1-58829-628-8. 240 pages, $89.50. The editors preface this book by stating that the setting in which a child experiences pain is a chief determinant of how the pain can and will be managed. Because of the importance of understanding the role of “place” in worldwide efforts to manage pediatric pain coupled with the lack of attention paid to this topic in the pediatric pain management literature, the editors have undertaken this challenge in writing this book. The book is organized into nine mostly well-written chapters by experts in their respective fields. The first three chapters are devoted to conventional settings for pediatric pain management. In chapter 1, the author provides a broad overview of the fundamental knowledge of pain neurobiology, pharmacology, and clinical practice guidelines required to understand and treat pediatric pain in the hospital setting. Also described are the common types of pediatric pain encountered in the hospital setting. The chapter is well written and well referenced. Chapter 2 reviews common pediatric pain problems seen in the office setting, including minor procedure pain such as results from immunizations; pain associated with illnesses such as otitis media, pharyngitis, and herpetic stomatitis; and finally chronic pain syndromes in children. The author thoroughly reviews the literature, which at times he acknowledges is scant, and makes recommendations regarding treatment based on the literature. His discussion of immunization pain and its management are highlights of this scholarly work. Chapter 3 addresses systematically the many factors that must be considered in treating pain during end-of-life care for children. The three middle chapters detail pediatric pain management in residential and school settings as well as explore the efficacy of a variety of complementary and alternative medicine interventions for several acute and chronic pain conditions in childhood. In chapter 4, the authors review the public health evidence in support of residential treatment for adolescents with chronic pain. They also provide a convincing argument for the unique therapeutic benefits of residential placement settings. Several current residential models of service are described in detail, including the health care-based programs offered by Dr. David Sherry at The Children’s Hospital of Philadelphia and their own setting, The Bath Pain Management Unit. Chapter 5 is a clinically focused review of the challenges that children and adolescents with chronic pain and their families commonly experience with respect to school absence and current interventions to facilitate school re-entry. Literature pertaining to pediatric pain treatment within the school setting is reviewed, with a particular emphasis on the work of Larsson and colleagues with adolescents experiencing chronic headaches. Chapter 6 is a thorough, rigorous, and scholarly review of the literature regarding the efficacy of complimentary and alternative medicine (CAM) interventions for acute and chronic pain conditions in children. The evaluation criteria employed were developed by the American Psychological Association Division 12 Task Force on Promotion and Dissemination of Psychological Procedures to assess nonpharmacological therapies. Interventions considered included acupuncture, biofeedback, music therapy, movement/dance therapy, herbal medicines, hypnosis, and massage. None of the interventions met the rigid criteria to qualify as an “empirically supported therapy.” However, the combination of self-hypnosis and relaxation met the standard for being labeled “efficacious” for recurrent pediatric headache. A few other interventions met the standards to be labeled “possibly efficacious” or “promising” for pediatric pain. Methodological flaws are identified in existing studies and a call for more rigorous scientific investigations of CAM is made. The authors include a very helpful table that summarizes the existing empirical evidence for efficacy of CAM interventions in pediatric pain. In the final chapters of the book, a variety of topics are covered to help improve pediatric pain management in a variety of settings. The potential for various technologies to facilitate the delivery of pediatric pain management services everywhere is discussed in chapter 7. The author argues that the implementation of technologies, including videoconferencing, telephone and web enabled systems of treatment, private computer networks, internet listservs, videos, electronic medical records, and personal digital assistants could lead to improved pediatric pain management by increasing access to care to children in isolated and remote areas and increasing the effectiveness of pain measurement and treatment. The author provides examples of technologies that have been already been used and the evidence for improved pain management resulting from their implantation. The authors’ “Family Help” program is a telephone-enabled program that relies on a manual, videos, and weekly telephone contact with a nonprofessional coach. There is also a Web-enabled version of this intervention. The programs has been used for adolescents with headaches and also recurrent abdominal pain. The authors caution that technology-enabled programs can be confusing and seem impersonal to patients and families and the cost of developing and implementing these programs is not insignificant. Yet the authors’ argue that implementation of these programs can in the long run result in reduced costs to patients, families, and health systems. The authors conclude that although technology offers the possibility of improving pediatric pain management, much work is still needed in development. Chapter 8 introduces the reader to the enormous problem of inadequate pain management for children throughout the developing world. Although comprehensive pediatric pain management program have appeared throughout the developed world in the last 20 years, pain services are largely unavailable to vast majority of children who reside in the developing world and suffer pain related to diseases (i.e., HIV/AIDS, cancer, sickle cell disease) as well as trauma (i.e., burns, war, terrorism, land mines). The numerous barriers to the development of pain management services are discussed. The authors report on the experiences of individuals who are endeavoring to improve pediatric pain care in several developing countries. Finally, in chapter 9, the authors propose that the primary obstacle to improving pediatric pain care everywhere is knowledge translation or a failure to put to use what we already know from existing research. They review the field of knowledge translation and argue that relying on the passive dissemination of pediatric pain research is not an effective method of influencing the pain management decisions of health care providers. In summary, Bringing Pain Relief to Children, is an enjoyable and readable book, each of whose nine chapters deal with some aspect of how to better deliver pain management services to children in a variety of settings. Although this book will not be of interest to many anesthesiologists, it is an essential book to read and a helpful resource for residents, fellows, and attending anesthesiologists interested in the management of acute and (especially) chronic pediatric pain. John B. Rose, MD Clinical Director, Pain Management Service Department of Anesthesiology and Critical Care Medicine Children’s Hospital of Philadelphia, and Associate Professor of Anesthesiology and Pediatrics University of Pennsylvania, School of Medicine Philadelphia, PA [email protected]