starPain Management

When a child is in pain, it’s impossible for him or her to focus on the many wonderful aspects of being a child. That’s why finding the right solutions to manage, or eliminate, pain is one of the most important medical decisions a parent will make. This of course can be extremely difficult when the child cannot communicate where the pain is coming from, which is often the case in these situations.

For children with brain injuries or cerebral palsy, pain falls into two categories: pain felt after surgery or another medical intervention, and pain felt every day because of the condition of his or her body. Though the former is something that a child will have to cope with during times when his or her medical team has identified surgical solutions meant to prevent pain during the long term, the latter is one that proves to be more devastating.

Pain that is the result of spasticity, or from musculoskeletal malformations, or even from sitting in a wheelchair for several hours a day must be addressed when there are no other feasible alternatives. For parents of children like ours, pain management is an every-day proposition comprised of therapies, medications, and communication – there has to be a constant effort to relieve pain on the part of physicians, and parents.

Some of the root causes of pain include:

  • Orthopedic pain – Deformed bones, misplaced bones, hip subluxation, bone degeneration, scoliosis
  • Gastrointestinal pain – Impaired orofacial function, aspiration, incontinence, constipation, malabsorption
  • Surgical pain – Pain derived from surgical procedures, or invasive procedures
  • Rehabilitative pain – Discomfort that results from taking part in physical and occupational therapy

The most common medications used to treat pain in children and adults with cerebral palsy include:

  • Anticonvulsants – Medication used to reduce seizure activity, and reduce the intensity of seizures.
  • Anticholinergics – Used to treat uncontrolled movements and spasms caused by spasticity, dystonia, athetosis, or chorea. Medication stimulates the central nervous system.
  • Anti-spastics – Used to relax muscles by relieving muscles that are over-contracted or stiff. Medication can also reduce spasticity and tremors.
  • Anti-inflammatories – Used to relieve pain by reducing inflammations of the muscles and joints.
  • Opioids – Analgesic prescription medication used to relieve severe pain.
  • Stool softeners – Used to relieve constipation, which can bring significant relief from abdominal pain.
  • Antidepressants – Used to relieve symptoms of depression and anxiety. Active ingredients alter a person’s mood.

All medications – even if they are purchased over-the-counter – should be strictly monitored by a child’s physician as well as his or her parent or caregiver. So far we have found that the best people to advise on pain relief are those with a knowledge of ongoing Palliative care. With support from a Palliative care expert the parent is the best person to monitor what is and isn’t working for their child, they spend more time with them and know them better than anyone. It can be a long drawn out exercise but you will get there in the end. The best Palliative experts are generally found in hospices where pain relief and Palliative care are their main focus. Emily Harrop our resident Expert is a Consultant in Paediatric Palliative Care at Helen & Douglas House, she says:

‘Most children’s hospices have access to doctors and nurses with expertise in pain assessment and symptom management. A referral to a children’s hospice may therefore help with symptom assessment, as well as providing some useful respite. Details of the nearest service can be found on the Together for Short Lives website.’

Useful Resources

Emily Harrop
Consultant in Paediatric Palliative Care