From Yale University
Innovative techniques for managing pain help minimize children's suffering at Yale's pediatric pain management services
Using acupuncture, cryoblation (nerve freezing), controlled breathing, diversion and other innovative techniques in addition to medicines, physicians at Yale's Pediatric Pain Management Services (PPMS) are providing relief to children who experience pain as a result of surgery, chronic illness or routine vaccinations.
"There is no reason for any child to suffer through a medical procedure, however minor it may be," said Brenda McClain, associate professor of anesthesiology at Yale School of Medicine and director of PPMS, which is located at Yale-New Haven Children's Hospital. "Many families do not know that their children can get pain relief for procedures as minor as a vaccination. Simply applying a mixture of local anesthetics like EMLA cream, can significantly reduce the trauma and fear associated with these routine procedures."
In the past, some physicians and parents were hesitant to use common pain medications in children for fear they were too strong. Others believed the infant nervous system was too immature to feel pain. Current research, however, shows that even premature infants feel pain and that young infants may be more vulnerable to pain than adults. Of the millions of children who have surgery each year, many of them receive inadequate pain relief, which prolongs the recovery period and can delay wound healing. This could result in heightened sensitivity to pain, a change in temperament, and distrust of adults, physicians and other caregivers. When proper pain management is used, physicians have observed a faster return to normal activities, a lower risk of complications and shorter hospital stays.
"Throughout my career, I saw a lot of children who were suffering and I began to see the depth and breadth of the problem," said McClain. "While safeguards exist, like the pediatric patient bill of rights, and the upcoming JCAHO mandate for pain assessment and pain management in all patients, we still have some of the same beliefs that 'children will get over it,' or that 'pain builds character and strength.'"
McClain said that in addition to conventional pain medications, alternative pain remedies are also catching on.
"Acupuncture and naturopathic approaches are often requested by families and therefore it requires our services to be abreast of appropriate applications of these philosophies," said McClain, who plans to develop a puppet show and a coloring book for children to foster better coping mechanisms.
McClain adds that distraction works well with children. "Children respond extremely well to hypnosis or distractions designed to take attention away from the site of pain," said McClain. "At Yale, pediatric anesthesiologists work with child life specialists who are expert in play therapy and child behavior, to help children understand why they are experiencing pain and to maximize coping skills. This also helps instill in children that pain is not a form of punishment for something they did wrong."
In addition to acute pain management for medical and perioperative care, PPMS supports a pediatric chronic pain clinic and sees over 50 cases annually in the Pediatric Specialty Clinic. Conditions treated include migraine headaches, cancer pain, muscle and skeletal pain and nerve-related pain disorders.
"Pain should not be viewed as an isolated occurrence, since it affects every aspect of a person's life," said McClain. "The Pediatric Chronic Pain Clinic coordinates physical therapy and behavioral interventions as a multidisciplinary approach to the well-being of the whole child."