A child with pain syndrome in the office of the general practitioner
Wassily M. Delyagin
Russian Family Doctor ›› 2023, Vol. 27 ›› Issue (2) : 11 -22.
A child with pain syndrome in the office of the general practitioner
Pain as a problem of a pediatrician and a family doctor is very common, often requiring interdisciplinary and interprofessional approaches. The first step in optimizing pain management is its assessment and characteristics, taking into account the age and development of the patient. The priority is self-reported pain. Objectification of the characteristics of pain is achieved by using scales, including, if possible, with an objective instrumental and laboratory assessment. Various options for pain assessment scales are presented. Treatment is based on the elimination of the cause of pain, the use of drug and non-drug interventions. Information is given about the age-related characteristics of the reaction to analgesics and recommendations for their use. The planning and implementation of strategies for treating pain in children should be personalized and family oriented.
children / teenagers / pain / diagnostics / analgesics / nonpharmacological management
| [1] |
Raja S, Carr D, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–1982. DOI: 10.1097/j.pain.0000000000001939 |
| [2] |
Raja S., Carr D., Cohen M. et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises // Pain. 2020. Vol. 161, No. 9. P. 1976–1982. DOI: 10.1097/j.pain.0000000000001939 |
| [3] |
Delyagin VM, Maltsev VI, Rumyantsev AG. Lectures on clinical diagnostics of internal diseases. Kyiv: MORION; 2007. 663 p. (In Russ.) |
| [4] |
Делягин В.М., Мальцев В.И., Румянцев А.Г. Лекции по клинической диагностике внутренних болезней. Киев: МОРИОН, 2007. 663 с. |
| [5] |
Palermo T. Assessment of chronic pain in children: Current status and emerging topics. Pain Res Manag. 2009;14(1):21–26. DOI: 10.1155/2009/236426 |
| [6] |
Palermo T. Assessment of chronic pain in children: Current status and emerging topics // Pain Res. Manag. 2009. Vol. 14, No. 1. P. 21–26. DOI: 10.1155/2009/236426 |
| [7] |
Trottier E, Ali S, Doré-Bergeron M-J, Chauvin-Kimoff L. Best practices in pain assessment and management for children. Paediatr Child Health. 2022;27(7):429–437. DOI: 10.1093/pch/pxac048 |
| [8] |
Trottier E., Ali S., Doré-Bergeron M.-J., Chauvin-Kimoff L. Best practices in pain assessment and management for children // Paediatr. Child Health. 2022. Vol. 27, No. 7. P. 429–437. DOI: 10.1093/pch/pxac04 |
| [9] |
Delyagin WM, Rumyantsev AG, Chernov VM, et al. Rasprostranennost’ nekotorykh zabolevanii sredi shkol’nikov po dannym massovykh dispansernykh osmotrov. Proceedings of the conference “Zdorov’e, obuchenie, vospitanie detei i molodezhi v XXI veke”, Moscow, May 12–14, 2004. Moscow; 2004. P. 331–333. (In Russ.) |
| [10] |
Делягин В.М., Румянцев А.Г., Чернов В.М. и др. Распространенность некоторых заболеваний среди школьников по данным массовых диспансерных осмотров // Материалы международного конгресса «Здоровье, обучение, воспитание детей и молодежи в XXI веке», Москва, 12–14 мая 2004 года. Москва, 2004. С. 331–333. |
| [11] |
Delyagin WM, Karpin LE, Chechelnitskaya SM, Rumyantsev AG. Rasprostranennost’ ehndokrinologicheskoi zabolevaemosti sredi shkol’nikov po itogam massovykh dispansernykh osmotrov. Children Hospital (Detskaya bol’nitsa). 2005;3(21):10–12. (In Russ.) |
| [12] |
Делягин В.М., Карпин Л.Е., Чечельницкая С.М., Румянцев А.Г. Распространенность эндокринологической заболеваемости среди школьников по итогам массовых диспансерных осмотров // Детская больница. 2005. Т. 3, № 21. С. 10–12. |
| [13] |
Budchanova NYu. Primary headaches in schoolchildren (epidemiology, clinic, analysis of the factors of their development) [dissertation]. Moscow; 2008. 28 p. (In Russ.) |
| [14] |
Будчанова Н.Ю. Первичные головные боли у школьников (эпидемиология, клиника, анализ факторов их развития): автореф. дисс. … канд. мед. наук. Москва, 2008. 28 с. |
| [15] |
Aristanagaliev MT. Sindrom retsidiviruyushchikh bolei vnizu zhivota u mal’chikov (klinicheskoe znachenie ehkhograficheskikh priznakov dlya differentsial’noi diagnostiki i lecheniya) [dissertation]. Moscow; 2004. 25 p. (In Russ.) |
| [16] |
Аристанагалиев М.Т. Синдром рецидивирующих болей внизу живота у мальчиков (клиническое значение эхографических признаков для дифференциальной диагностики и лечения): автореф. дисс. … канд. мед. наук. Москва, 2004. 25 с. |
| [17] |
McCormick D. Otitis media: immediate antibiotics or watchful waiting? Pediatric Health. 2007;1(1). DOI: 10.2217/17455111.1.1.107 |
| [18] |
McCormick D. Otitis media: immediate antibiotics or watchful waiting? // Pediatric. Health. 2007. Vol. 1, No. 1. DOI: 10.2217/17455111.1.1.107 |
| [19] |
Hauer J, Houtrow AJ. Pain assessment and treatment in children with significant impairment of the central nervous system. Pediatrics. 2017;139(6):e20171002. DOI: 10.1542/peds.2017-1002 |
| [20] |
Hauer J., Houtrow A.J. Pain assessment and treatment in children with significant impairment of the central nervous system // Pediatrics. 2017. Vol. 139, No. 6. P. e20171002. DOI: 10.1542/peds.2017-1002 |
| [21] |
Chan A, Ge M, Harrop E, et al. Pain assessment tools in paediatric palliative care: A systematic review of psychometric properties and recommendations for clinical practice. Palliat Med. 2022;36(1):30–43. DOI: 10.1177/02692163211049309 |
| [22] |
Chan A., Ge M., Harrop E. et al. Pain assessment tools in paediatric palliative care: a systematic review of psychometric properties and recommendations for clinical practice // Palliat. Med. 2022. Vol. 36, No. 1. P. 30–43. DOI: 10.1177/02692163211049309 |
| [23] |
Tomlinson D, Baeyer C, Stinson J, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics. 2010;126(5):e1168–98. DOI: 10.1542/peds.2010-1609 |
| [24] |
Tomlinson D., Baeyer C., Stinson J., Sung L. A systematic review of faces scales for the self-report of pain intensity in children // Pediatrics. 2010. Vol. 126, No. 5. P. e1168–98. DOI: 10.1542/peds.2010-1609 |
| [25] |
Kusumaningrum A, Rustina Y, Abuzairu T, et al. Analysis of the infant’s acute pain assessment using developed conductance skin electric instrument compared to the behavioural and faces pain scale in painful injected vaccine. Pediatr Med Chir. 2023;45(s1). DOI: 10.4081/pmc.2023.312 |
| [26] |
Kusumaningrum A., Rustina Y., Abuzairu T. et al. Analysis of the infant’s acute pain assessment using developed conductance skin electric instrument compared to the behavioural and faces pain scale in painful injected vaccine // Pediatr. Med. Chir. 2023. Vol. 45, No. s1. DOI: 10.4081/pmc.2023.312 |
| [27] |
Whitley GA, Hemingway P, Law GR, et al. The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: a systematic mixed studies review. J Child Health Care. 2021;25(3):481–503. DOI: 10.1177/1367493520949427 |
| [28] |
Whitley G.A., Hemingway P., Law G.R. et al. The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review // J. Child Health Care. 2021. Vol. 25, No. 3. P. 481–503. DOI: 10.1177/1367493520949427 |
| [29] |
Ali S, McGrath T, Drendel A. An evidence-based approach to minimizing acute procedural pain in the emergency department and beyond. Pediatr Emerg Care. 2016;32(1):36–42; quiz 43–44. DOI: 10.1097/PEC.0000000000000669 |
| [30] |
Ali S., McGrath T., Drendel A. An evidence-based approach to minimizing acute procedural pain in the emergency department and beyond // Pediatr. Emerg. Care. 2016. Vol. 32, No. 1. P. 36–42; quiz 43–44. DOI: 10.1097/PEC.0000000000000669 |
| [31] |
Mathews L. Pain in children: Neglected, unaddressed and mismanaged. Indian J Palliat Care. 2011;17(Suppl):S70–S73. DOI: 10.4103/0973-1075.76247 |
| [32] |
Mathews L. Pain in children: Neglected, unaddressed and mismanaged // Indian J. Palliat. Care. 2011. Vol. 17, No. Suppl. P. S70–S73. DOI: 10.4103/0973-1075.76247 |
| [33] |
Grunau R, Whitfield M, Petrie-Thomas J, et al. Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants. Pain. 2009;143(1–2):138–146. DOI: 10.1016/j.pain.2009.02.014 |
| [34] |
Grunau R., Whitfield M., Petrie-Thomas J. et al. Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants // Pain. 2009. Vol. 143, No. 1–2. P. 138–146. DOI: 10.1016/j.pain.2009.02.014 |
| [35] |
Valeri B, Ranger M, Chau C, et al. Neonatal invasive procedures predict pain intensity at school age in children born very preterm. Clin J Pain. 2016;32(12):1086–1093. DOI: 10.1097/AJP.0000000000000353 |
| [36] |
Valeri B., Ranger M., Chau C. et al. Neonatal invasive procedures predict pain intensity at school age in children born very preterm // Clin. J. Pain. 2016. Vol. 32, No. 12. P. 1086–1093. DOI: 10.1097/AJP.0000000000000353 |
| [37] |
Trottier E, Bergeron M, Chauvin-Kimoff L, et al. Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures. Paediatr Child Health. 2019;24(8):509–521. DOI: 10.1093/pch/pxz026 |
| [38] |
Trottier E., Bergeron M., Chauvin-Kimoff L. et al. Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures // Paediatr. Child Health. 2019. Vol. 24, No. 8. P. 509–521. DOI: 10.1093/pch/pxz026 |
| [39] |
Angeles D, Boskovic D, Tan J, et al. Oral dextrose reduced procedural pain without altering cellular ATP metabolism in preterm neonates: a prospective randomized trial. J Perinatol. 2020;40:888–895. DOI: 10.1038/s41372-020-0634-0 |
| [40] |
Angeles D., Boskovic D., Tan J. et al. Oral dextrose reduced procedural pain without altering cellular ATP metabolism in preterm neonates: a prospective randomized trial // J. Perinatol. 2020. Vol. 40. P. 888–895. DOI: 10.1038/s41372-020-0634-0 |
| [41] |
Pillai Riddell RR, Racine NM, Gennis HG, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev. 2015;2015(12):CD006275. DOI: 10.1002/14651858.CD006275.pub3 |
| [42] |
Pillai Riddell R.R., Racine N.M., Gennis H.G. et al. Non-pharmacological management of infant and young child procedural pain // Cochrane Database Syst. Rev. 2015. Vol. 2015, No. 12. P. CD006275. DOI: 10.1002/14651858.CD006275.pub3 |
| [43] |
Wu Y, Zhao Y, Wu L, et al. Non-pharmacological management for vaccine-related pain in children in the healthcare setting: a scoping review. J Pain Res. 2022;15:773–2782. DOI: 10.2147/JPR.S371797 |
| [44] |
Wu Y., Zhao Y., Wu L. et al. Non-pharmacological management for vaccine-related pain in children in the healthcare setting: a scoping review // J. Pain Res. 2022. Vol. 15. P. 2773–2782. DOI: 10.2147/JPR.S371797 |
| [45] |
Paes V, Silva-Rodriges F, de Avila L. Non-pharmacological methods for pain management in pediatric oncology: evidences in literature. Rev Bras Cancerol. 2021;67(2):e–031027. DOI: 10.32635/2176-9745.RBC.2021v67n2.1027 |
| [46] |
Paes V., Silva-Rodriges F., de Avila L. Non-pharmacological methods for pain management in pediatric oncology: evidences in literature // Rev. Bras. Cancerol. 2021. Vol. 67, No. 2. P. e031027. DOI: 10.32635/2176-9745.RBC.2021v67n2.1027 |
| [47] |
Veelen S, Vuong C, Gerritsma J, et al. Efficacy of non-pharmacological interventions to reduce pain in children with sickle cell disease: A systematic review. Pediatr Blood Cancer. 2023;70:e30315. DOI: 10.1002/pbc.30315 |
| [48] |
Veelen S., Vuong C., Gerritsma J. et al. Efficacy of non-pharmacological interventions to reduce pain in children with sickle cell disease: A systematic review // Pediatr. Blood Cancer. 2023. Vol. 70. P. e30315. DOI: 10.1002/pbc.30315 |
| [49] |
Mangoni A, Jackson S. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2003;57(1):6–14. DOI: 10.1046/j.1365-2125.2003.02007.x |
| [50] |
Mangoni A., Jackson S. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications // Br. J. Clin. Pharmacol. 2003. Vol. 57, No. 1. P. 6–14. DOI: 10.1046/j.1365-2125.2003.02007.x |
| [51] |
Batton DG, Barrington KJ, Wallman C. Canadian Paediatric Society, Fetus and Newborn Committee. Prevention and management of pain in the neonate: an update. Pediatrics. 2006;118(5):2231–2241. DOI: 10.1542/peds.2006-2277 |
| [52] |
Batton D.G., Barrington K.J., Wallman C. Canadian Paediatric Society, Fetus and Newborn Committee. Prevention and management of pain in the neonate: an update // Pediatrics. 2006. Vol. 118, No. 5. P. 2231–2241. DOI: 10.1542/peds.2006-2277 |
| [53] |
Chumpitazi C, Chang C, Atanelov Z, et al. Managing acute pain in children presenting to the emergency department without opioids. J Am Coll Emerg Physicians Open. 2022;3(2):e12664. DOI: 10.1002/emp2.12664 |
| [54] |
Chumpitazi C., Chang C., Atanelov Z. et al. Managing acute pain in children presenting to the emergency department without opioids // J. Am. Coll. Emerg. Physicians Open. 2022. Vol. 3, No. 2. P. e12664. DOI: 10.1002/emp2.12664 |
| [55] |
May L, Ali S, Khadra C, et al. Pain management of pediatric musculoskeletal injury in the emergency department: a systematic review. Pain Res Manag. 2016;2016:4809394. DOI: 10.1155/2016/4809394 |
| [56] |
May L., Ali S., Khadra C. et al. Pain management of pediatric musculoskeletal injury in the emergency department: a systematic review // Pain Res. Manag. 2016. Vol. 2016. P. 4809394. DOI: 10.1155/2016/4809394 |
| [57] |
Tan F, Braithwaite I, McKinlay C, Dalziel S. Comparison of acetaminophen (paracetamol) with ibuprofen for treatment of fever or pain in children younger than 2 years: a systematic review and metaanalysis. JAMA Netw Open. 2020;3(10):e2022398. DOI: 10.1001/jamanetworkopen.2020.22398 |
| [58] |
Tan F., Braithwaite I., McKinlay C., Dalziel S. Comparison of acetaminophen (paracetamol) with ibuprofen for treatment of fever or pain in children younger than 2 years: a systematic review and metaanalysis // JAMA Netw. Open. 2020. Vol. 3, No. 10. P. e2022398. DOI: 10.1001/jamanetworkopen.2020.22398 |
| [59] |
Poonai N, Datoo N, Ali S, et al. Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: A randomized controlled trial. CMAJ. 2017;189(40):E1252–E1258. DOI: 10.1503/cmaj.170017 |
| [60] |
Poonai N., Datoo N., Ali S. et al. Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: A randomized controlled trial // CMAJ. 2017. Vol. 189, No. 40. P. E1252–E1258. DOI: 10.1503/cmaj.170017 |
| [61] |
Kelly L, Sommer D, Ramakrishna J, et al. Morphine or ibuprofen for post-tonsillectomy analgesia: a randomized trial. Pediatrics. 2015;135(2):307–313. DOI: 10.1542/peds.2014-1906 |
| [62] |
Kelly L., Sommer D., Ramakrishna J. et al. Morphine or ibuprofen for post-tonsillectomy analgesia: a randomized trial // Pediatrics. 2015. Vol. 135, No. 2. P. 307–313. DOI: 10.1542/peds.2014-1906 |
| [63] |
Macintyre P, Schug S. Acute pain management: a practical guide. 4th ed. CRC Press; 2014. 287 p. DOI: 10.1201/b17905 |
| [64] |
Macintyre P., Schug S. Acute pain management: a practical guide. 4th ed. CRC Press. 2014. 287 p. DOI: 10.1201/b17905 |
| [65] |
Gai N, Naser B, Hanley J, et al. A practical guide to acute pain management in children. J Anesth. 2020;34(3):421–433. DOI: 10.1007/s00540-020-02767-x |
| [66] |
Gai N., Naser B., Hanley J. et al. A practical guide to acute pain management in children // J. Anesth. 2020. Vol. 34, No. 3. P. 421–433. DOI: 10.1007/s00540-020-02767-x |
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