Walco / Goldschneider Pain in Children

A Practical Guide for Primary Care
1. Auflage 2008
ISBN: 978-1-59745-476-6
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 279 Seiten

Advances over the past two decades have enabled physicians to revolutionize the manner in which they can assess and manage children's pain. Thirty years ago it was thought that young children did not experience pain and therefore it was not necessary to treat it. Today professionals from a variety of disciplines have contributed data that have revolutionized medical perspectives. Technological advances now enable doctors to treat acute pain in fetuses, premature neonates, infants, toddlers, children, and adolescents with increasing precision and efficacy. Research highlighting the context of chronic pain has moved them away from a mind-body dichotomy and toward an integrated, holistic perspective that leads to substantial improvement in children's adaptive functioning as well as subjective discomfort. This book covers these topics and is intended for anyone who provides medical care to children. Each chapter provides an overview of the problem, followed by a 'hands on' description of relevant assessment and intervention strategies. The role of the primary care practitioner is highlighted, both as a front-line resource as well as a consumer of specialized pediatric pain treatment services. Each chapter ends with a summary and specific bullet points highlighting the most central elements, making for quick and easy reference.

Autoren/Hrsg.

Walco, Gary A.

Goldschneider, Kenneth R.

Inhaltsverzeichnis

1;Dedication;5
2;Foreword;7
3;Preface;11
4;Acknowledgements;13
5;Table of Contents;15
6;Contributors;19
7;Part I: General Considerations;23
7.1;Chapter 1;24
7.1.1;Pain and the Primary Pediatric Practitioner;24
7.1.1.1;Introduction;24
7.1.1.2;1. Managing Pain in Children: Your Ethical Obligation;26
7.1.1.3;2. Development of Pain Systems;26
7.1.1.4;3. Individual Differences in Pain Response;27
7.1.1.4.1;3.1. Genetics of Pain Response;27
7.1.1.4.2;3.2. Temperament;27
7.1.1.5;4. Consequences of Untreated Pain in the Young;28
7.1.1.6;Take-Home Points;28
7.1.1.7;References;28
7.2;Chapter 2;30
7.2.1;Developmental Issues in Understanding, Assessing, and Managing Pediatric Pain;30
7.2.1.1;Introduction;30
7.2.1.2;1. The Child in Pain;32
7.2.1.3;2. The Role of the Caregiver;32
7.2.1.4;3. Domains of Development;32
7.2.1.4.1;3.1. Physical Growth;33
7.2.1.4.2;3.2. Cognitive Capabilities;33
7.2.1.4.3;3.3. Emotional Processing;34
7.2.1.4.4;3.4. Behavioral Competence;35
7.2.1.4.5;3.5. Social Interaction;35
7.2.1.5;4. Stages of Development;36
7.2.1.5.1;4.1. Newborns;36
7.2.1.5.2;4.2. Infants;36
7.2.1.5.3;4.3. Toddlers;37
7.2.1.5.4;4.4. Preschoolers;37
7.2.1.5.5;4.5. Elementary School-Aged Children;38
7.2.1.5.6;4.6. Adolescence;38
7.2.1.6;Take-Home Points;39
7.2.1.7;References;39
7.3;Chapter 3;42
7.3.1;Measurement and Assessment of Pediatric Pain in Primary Care;42
7.3.1.1;1. Measurement of Pain: Why and How?;42
7.3.1.2;2. Pain Measurement in Primary Care Versus Specialized Settings;42
7.3.1.3;3. How Pain is Measured;42
7.3.1.4;4. Interpretation and Use of Pain Scores;43
7.3.1.5;5. Neonates, Infants, and Toddlers up to 2 Years;43
7.3.1.6;6. Preschool-Age Children (3 to 5 Years);44
7.3.1.7;7. School-Age Children (6 to 12 Years);44
7.3.1.8;8. Adolescents;45
7.3.1.9;9. Children with Developmental Disabilities;45
7.3.1.10;10. Children in Critical Care;45
7.3.1.11;11. Four Brief Case Examples;45
7.3.1.11.1;11.1. Self-Report Numerical Pain Scores in a Headache Diary;46
7.3.1.11.2;11.2. Self-Report Faces Pain Scores in Repeated Injections;46
7.3.1.11.3;11.3. Observation by Parents to Control Post-Tonsillectomy Pain at Home;46
7.3.1.11.4;11.4. Physician’s Use of a Global Numerical Rating Scale in a Busy Infant Ward;46
7.3.1.12;Take-Home Points;46
7.3.1.13;References;47
7.4;Chapter 4;50
7.4.1;Pain Management for Children with a Developmental Disability in a Primary Care Setting;50
7.4.1.1;Introduction;50
7.4.1.2;1. What is a Developmental Disability and Where is the Pain?;50
7.4.1.3;2. What Is an SNI and How Can it Lead to Painful Conditions?;51
7.4.1.4;3. Pain Expression in SNI;52
7.4.1.5;4. Pain Assessment;52
7.4.1.6;5. Investigation of Pain in a Child with an SNI;53
7.4.1.7;6. Pain Management;55
7.4.1.7.1;6.1. Analgesics;55
7.4.1.7.2;6.2. Drug Interactions;55
7.4.1.7.3;6.3. Drug Trials;56
7.4.1.7.4;6.4. Acute Pain;56
7.4.1.8;Take-Home Points;57
7.4.1.9;Recommended Reading Material;57
7.4.1.10;References;57
7.5;Chapter 5;60
7.5.1;Remote Management of Pediatric Pain;60
7.5.1.1;Introduction;60
7.5.1.2;1. Pediatrician to Patient and Family;61
7.5.1.2.1;1.1. Assessment at a Distance;61
7.5.1.2.2;1.2. Treatment at a Distance;62
7.5.1.2.3;1.3. Schools at a Distance;64
7.5.1.2.4;1.4. When to Refer to a Pain Service;64
7.5.1.3;2. Pediatric Pain Specialist Care to Patient and Family;65
7.5.1.3.1;2.1. Pediatric Pain Clinic Assessment at a Distance;65
7.5.1.3.2;2.2. Pediatric Pain Clinic Treatment at a Distance;65
7.5.1.3.3;2.3. Pediatric Pain Clinic and Schools at a Distance;66
7.5.1.3.4;2.4. Pediatric Pain Clinic and Distance Specific Treatments;66
7.5.1.4;3. Professional-to-Professional Consultation;67
7.5.1.5;4. Ethical/Legal Issues;69
7.5.1.6;5. Conclusion;69
7.5.1.7;Take-Home Points;69
7.5.1.8;References;69
7.5.1.9;Appendix A;71
8;Part II: Acute Pain Management;74
8.1;Chapter 6;76
8.1.1;Pain Management in the Primary Care Office;76
8.1.1.1;Introduction;76
8.1.1.2;1. Pains in Normal Growth and Development;77
8.1.1.2.1;1.1. Teething;77
8.1.1.2.2;1.2. Colic;77
8.1.1.2.3;1.3. Growing Pains;78
8.1.1.3;2. Pain Associated with Acute Infections;79
8.1.1.3.1;2.1. Otitis Media;79
8.1.1.3.2;2.2. Pharyngitis;80
8.1.1.3.3;2.3. Summary;80
8.1.1.4;3. Pain Associated with Minor Injuries;80
8.1.1.5;4. Creating a Pain-Friendly Office;81
8.1.1.5.1;4.1. Setting the Stage;81
8.1.1.5.2;4.2. Education;82
8.1.1.5.2.1;4.2.1. Parents and Children;82
8.1.1.5.2.2;4.2.2. Staff Education;82
8.1.1.5.3;4.3. Cultivating Relationships with Outside Providers;82
8.1.1.5.4;4.4. Office Environment;83
8.1.1.6;5. Summary;83
8.1.1.7;Take-Home Points;83
8.1.1.8;References;84
8.2;Chapter 7;86
8.2.1;Topical Anesthetics and Office-Based Procedures;86
8.2.1.1;Introduction;86
8.2.1.2;1. Needle Procedures: Immunizations, Venous Access, and Heel Lance;86
8.2.1.2.1;1.1. Prior to the Needle Procedure;87
8.2.1.2.1.1;1.1.1. Preparation;87
8.2.1.2.1.2;1.1.2. Site;87
8.2.1.2.1.3;1.1.3. Needle Type;87
8.2.1.2.1.4;1.1.4. Injectate Properties;88
8.2.1.2.2;1.2. During the Procedure;88
8.2.1.2.2.1;1.2.1. Parental Demeanor;88
8.2.1.2.2.2;1.2.2. Distraction;89
8.2.1.2.2.3;1.2.3. Topical Anesthetics;89
8.2.1.2.2.4;1.2.4. Complementary Analgesia for Infants;90
8.2.1.2.2.5;1.2.5. Physical Methods;90
8.2.1.2.2.6;1.2.6. Simultaneous Injection;90
8.2.1.3;2. Urinary Catheterization;90
8.2.1.4;3. Summary and Other Procedures;91
8.2.1.5;Take-Home Points;91
8.2.1.6;References;91
8.3;Chapter 8;94
8.3.1;Analgesic Medications for Acute Pain Management in Children;94
8.3.1.1;Introduction;94
8.3.1.2;1. Nonsteroidal Anti-Inflammatory Drugs;95
8.3.1.2.1;1.1. Nonspecific Cyclooxegenase Inhibitors;95
8.3.1.2.1.1;1.1.1. Acetylsalicylic Acid (Aspirin);95
8.3.1.2.1.2;1.1.2. Acetaminophen;95
8.3.1.2.1.3;1.1.3. Ibuprofen;97
8.3.1.2.1.4;1.1.4. Naproxen;97
8.3.1.2.1.5;1.1.5. Etodolac;97
8.3.1.2.1.6;1.1.6. Ketorolac;97
8.3.1.2.2;1.2. COX-2 Inhibitors;97
8.3.1.3;2. Opioids;97
8.3.1.3.1;2.1. Agonists and Antagonists;98
8.3.1.3.2;2.2. Adverse Drug Reaction;98
8.3.1.3.3;2.3. Recommended Doses;98
8.3.1.3.4;2.4. Morphine;98
8.3.1.3.4.1;2.4.1. Fentanyl;99
8.3.1.3.4.2;2.4.2. Hydromorphone;100
8.3.1.3.4.3;2.4.3. Meperidine;100
8.3.1.3.4.4;2.4.4. Methadone;100
8.3.1.3.4.5;2.4.5. Codeine;101
8.3.1.3.4.6;2.4.6. Oxycodone and Hydrocodone;101
8.3.1.3.4.7;2.4.7. Tramadol;101
8.3.1.3.4.8;2.4.8. Nalbuphine;102
8.3.1.3.4.9;2.4.9. Naloxone;102
8.3.1.4;3. Approaches to Opioid Use;102
8.3.1.4.1;3.1. Patient-Controlled Analgesia;103
8.3.1.4.2;3.2. Continuous Opioid Infusions;104
8.3.1.5;4. Nontraditional Analgesics;104
8.3.1.5.1;4.1. Antidepressants;104
8.3.1.5.2;4.2. Anticonvulsants;105
8.3.1.6;Take-Home Points;105
8.3.1.7;References;105
8.4;Chapter 9;108
8.4.1;Pain Management in the Emergency Department;108
8.4.1.1;Introduction;108
8.4.1.2;1. Advances in ED Pain Management;108
8.4.1.2.1;1.1. Procedural Sedation and Analgesia;108
8.4.1.2.2;1.2. Simple Procedural Pain Management;109
8.4.1.2.3;1.3. Acute Abdominal Pain;110
8.4.1.3;2. Nonpharmacologic Interventions;110
8.4.1.4;3. Pharmacologic Interventions;110
8.4.1.5;4. Preparing the Patient for an ED Visit;110
8.4.1.6;5. Pre-Hospital Pain Management;111
8.4.1.7;Take-Home Points;111
8.4.1.8;References;111
8.5;Chapter 10;114
8.5.1;Preparing Children for Invasive Procedures and Surgery;114
8.5.1.1;Introduction;114
8.5.1.2;1. Factors Associated with Pediatric Pain During Invasive Procedures;115
8.5.1.2.1;1.1. Nonmalleable Predictors of Children’s Pain and Distress;115
8.5.1.2.2;1.2. Malleable Predicators of Children’s Pain and Distress;115
8.5.1.3;2. Assessment of Pain, Distress, and Coping;116
8.5.1.4;3. Interventions for Acute Procedures;116
8.5.1.4.1;3.1. Pharmacologic Approaches;116
8.5.1.4.2;3.2. Psychological Interventions for Procedure-Related Pain;116
8.5.1.5;4. Interventions to Reduce Presurgical Anxiety;117
8.5.1.5.1;4.1. Midazolam;117
8.5.1.5.2;4.2. Parental Presence;118
8.5.1.5.3;4.3. Preparation Programs;118
8.5.1.6;5. When to Refer;119
8.5.1.6.1;5.1. For Further Information;119
8.5.1.7;Take-Home Points;119
8.5.1.8;References;119
8.6;Chapter 11;122
8.6.1;Pain Relief After Outpatient Surgery;122
8.6.1.1;Introduction;122
8.6.1.2;1. Regional Anesthesia for Outpatient Surgery;123
8.6.1.2.1;1.1. Caudal Anesthesia;123
8.6.1.2.1.1;1.1.1. Single Shot Caudals;123
8.6.1.2.2;1.2. Peripheral Nerve Blocks;124
8.6.1.2.2.1;1.2.1. Fascia Iliaca Block;124
8.6.1.2.2.2;1.2.2. Ilioinguinal/Iliohypogastric Nerve Blocks;124
8.6.1.2.2.3;1.2.3. Penile Blocks;125
8.6.1.2.3;1.3. Conclusions;125
8.6.1.3;2. Medication Management of Postoperative Pain;125
8.6.1.3.1;2.1. Acetaminophen;125
8.6.1.3.2;2.2. Nonsteroidal Anti-Inflammatory Drugs;126
8.6.1.3.3;2.3. Opioids;127
8.6.1.4;3. The Transition from Recovery Room to Home;128
8.6.1.5;Take-Home Points;128
8.6.1.6;References;129
8.7;Chapter 12;132
8.7.1;Regional Anesthesia;132
8.7.1.1;Introduction;132
8.7.1.2;1. Local Anesthetic Pharmacology;133
8.7.1.3;2. Regional Anesthetic Nerve Blocks and their Indications in Children;134
8.7.1.3.1;2.1. Head and Neck Blocks;134
8.7.1.3.1.1;2.1.1. Occipital Nerve Block;134
8.7.1.3.2;2.2. Upper Extremity Blocks;135
8.7.1.3.2.1;2.2.1. Interscalene Brachial Plexus Block;135
8.7.1.3.2.2;2.2.2. Infraclavicular Brachial Plexus Block;135
8.7.1.3.2.3;2.2.3. Axillary Brachial Plexus Block;136
8.7.1.3.2.4;2.2.4. Intravenous Regional (Bier) Block;136
8.7.1.3.3;2.3. Truncal Somatic and Visceral Blocks;136
8.7.1.3.3.1;2.3.1. Intercostal Nerve Block;136
8.7.1.3.3.2;2.3.2. Paravertebral Block;137
8.7.1.3.3.3;2.3.3. Rectus Sheath Nerve Block;137
8.7.1.3.3.4;2.3.4. Ilioinguinal and Iliohypogastric Nerve Block;137
8.7.1.3.3.5;2.3.5. Penile Block;138
8.7.1.3.3.6;2.3.6. Celiac Plexus Block;138
8.7.1.3.4;2.4. Lower Extremity Blocks;138
8.7.1.3.4.1;2.4.1. Lumbar Plexus Block;139
8.7.1.3.4.2;2.4.2. Femoral Nerve Block;139
8.7.1.3.4.3;2.4.3. Sciatic Nerve Block;139
8.7.1.3.4.4;2.4.4. Saphenous Nerve Block;139
8.7.1.3.4.5;2.4.5. Intravenous Regional (Bier) Block;140
8.7.1.3.5;2.5. Sympathetic Blocks;140
8.7.1.3.5.1;2.5.1. Stellate Ganglion Block;140
8.7.1.3.5.2;2.5.2. Lumbar Sympathetic Block;140
8.7.1.3.6;2.6. Neuraxial Nerve Blocks;141
8.7.1.3.6.1;2.6.1. Epidural Anesthesia (Thoracic, Lumbar);141
8.7.1.3.6.1.1;2.6.1.1. Caudal (Sacral) Epidural Anesthesia;142
8.7.1.3.6.1.2;2.6.1.2. Intrathecal (Spinal) Anesthesia;142
8.7.1.4;Take-Home Points;143
8.7.1.5;References;143
9;Part III: Recurrent and Chronic Pain Management;144
9.1;Chapter 13;146
9.1.1;How to Talk to Parents about Recurrent and Chronic Pain;146
9.1.1.1;Case Illustration;146
9.1.1.2;Introduction;146
9.1.1.3;1. Significance of Recurrent and Chronic Pain;147
9.1.1.4;2. A Biopsychosocial Framework;147
9.1.1.4.1;2.1. Explaining the Biopsychosocial Framework to Children and Parents;148
9.1.1.5;3. Clinical Evaluation of Recurrent and Chronic Pain;148
9.1.1.5.1;3.1. Communicating about Psychological Contributors and Interventions;149
9.1.1.6;4. Engaging the Parent in Counseling by the Physician;149
9.1.1.7;5. Guidelines in Making Referrals;150
9.1.1.8;Take-Home Points;151
9.1.1.9;References;151
9.2;Chapter 14;154
9.2.1;Multidisciplinary Approaches to Chronic Pain;154
9.2.1.1;Introduction;154
9.2.1.2;1. Models of Care;155
9.2.1.2.1;1.1. Multidisciplinary Pain Center;156
9.2.1.2.2;1.2. Multidisciplinary Pain Clinic;156
9.2.1.2.3;1.3. Pain Clinic;156
9.2.1.2.4;1.4. Modality-Oriented Clinic;156
9.2.1.3;2. Multidisciplinary Centers for Children;156
9.2.1.4;3. Organization of the Multidisciplinary Evaluation;158
9.2.1.4.1;3.1. Initial Physical Exam;159
9.2.1.4.2;3.2. Initial Physical/Occupational Therapy Exam;159
9.2.1.4.3;3.3. The Feedback Session;159
9.2.1.4.4;3.4. The MPC and Primary Physicians;159
9.2.1.4.5;3.5. Treatment and Cost-Effectiveness of MPCs;160
9.2.1.5;4. Specific Disease Examples;160
9.2.1.5.1;4.1. Complex Regional Pain Syndrome (CRPS) Type I;160
9.2.1.5.2;4.2. Musculoskeletal Pain and Fibromyalgia;161
9.2.1.5.3;4.3. Headache;161
9.2.1.5.4;4.4. Abdominal and Pelvic Pain;162
9.2.1.6;5. Conclusion;162
9.2.1.7;Take-Home Points;162
9.2.1.8;References;162
9.3;Chapter 15;166
9.3.1;Psychological Interventions for Chronic Pain;166
9.3.1.1;Introduction;166
9.3.1.2;1. Biofeedback-Assisted Relaxation Training;167
9.3.1.3;2. Pain Coping Skills Training;168
9.3.1.4;3. Parental Guidance in Behavior Management Techniques;169
9.3.1.5;4. Family-Based Intervention;171
9.3.1.6;5. Consultation with School Personnel;171
9.3.1.7;6. Psychiatric Consultation;172
9.3.1.8;Take-Home Points;172
9.3.1.9;References;172
9.4;Chapter 16;174
9.4.1;Complementary and Alternative Approaches for Chronic Pain;174
9.4.1.1;Introduction;174
9.4.1.2;1. CAM Treatments for Children and Adolescents;175
9.4.1.2.1;1.1. Acupuncture;175
9.4.1.2.2;1.2. Hypnotherapy;177
9.4.1.2.3;1.3. Biofeedback;177
9.4.1.2.4;1.4. Therapeutic Yoga;178
9.4.1.2.5;1.5. Massage;178
9.4.1.2.6;1.6. Meditation;178
9.4.1.2.7;1.7. Other CAM Treatments;178
9.4.1.3;2. Guidelines for Clinicians and Parents;179
9.4.1.4;Take-Home Points;179
9.4.1.5;Recommended Reading;180
9.4.1.6;References;180
10;Part IV: Common Recurrent and Chronic Pain Problems in Primary Care;182
10.1;Chapter 17;184
10.1.1;Functional Abdominal Pain;184
10.1.1.1;Introduction;184
10.1.1.2;1. Definition of FAP;184
10.1.1.3;2. Prevalence;185
10.1.1.4;3. Etiology;185
10.1.1.5;4. Biopsychosocial Model;186
10.1.1.6;5. Prognosis;187
10.1.1.7;6. Assessment of FAP;187
10.1.1.8;7. Treatment;187
10.1.1.8.1;7.1. Pharmacological Therapy;187
10.1.1.8.2;7.2. Dietary Management;188
10.1.1.8.3;7.3. Psychological Interventions;188
10.1.1.8.4;7.4. Other Treatment Options;189
10.1.1.9;8. Conclusion;189
10.1.1.10;Take-Home Points;189
10.1.1.11;References;190
10.2;Chapter 18;194
10.2.1;Headaches;194
10.2.1.1;Introduction;194
10.2.1.2;1. Migraine;195
10.2.1.2.1;1.1. Migraine without Aura;195
10.2.1.2.2;1.2. Migraine with Aura;195
10.2.1.2.3;1.3. Complications of Migraine;196
10.2.1.2.4;1.4. Other Features Characteristic of Juvenile Migraines;196
10.2.1.3;2. Childhood Periodic Syndromes;196
10.2.1.4;3. Tension-Type Headache (TTH);197
10.2.1.5;4. New Daily Persistent Headache (NDPH);197
10.2.1.6;5. Referral to Secondary/Tertiary Care;198
10.2.1.7;6. Management;198
10.2.1.7.1;6.1. Management of Acute Migraine;199
10.2.1.7.2;6.2. Management of Chronic Migraines;200
10.2.1.7.3;6.3. Managing Chronic Daily Headaches;200
10.2.1.7.4;6.4. Biobehavioral Treatment;201
10.2.1.7.5;6.5. Dietary Modifications and Supplements;202
10.2.1.7.6;6.6. Physical Therapy;202
10.2.1.7.7;6.7. Acupressure and Acupuncture;202
10.2.1.8;Take-Home Points;202
10.2.1.9;Recommended Reading;203
10.2.1.10;References;203
10.3;Chapter 19;206
10.3.1;Evaluating and Managing Pediatric Musculoskeletal Pain in Primary Care;206
10.3.1.1;Introduction;206
10.3.1.2;1. Diagnostic Issues in Pediatric Musculoskeletal Pain;207
10.3.1.2.1;1.1. Overview;207
10.3.1.2.2;1.2. Important Considerations when Taking a History;208
10.3.1.2.3;1.3. Physical Exam;209
10.3.1.2.4;1.4. Laboratory Tests;209
10.3.1.2.5;1.5. Radiographs;211
10.3.1.3;2. Specific Musculoskeletal Pain Problems;212
10.3.1.3.1;2.1. Back Pain;212
10.3.1.3.2;2.2. Complex Regional Pain Syndrome;214
10.3.1.4;3. Follow-Up and Referral;215
10.3.1.4.1;3.1. When to Refer to a Pediatric Rheumatologist;215
10.3.1.4.2;3.2. When to Refer to a Pediatric Pain Clinic;217
10.3.1.4.3;3.3. Other Referrals;218
10.3.1.5;Take-Home Points;218
10.3.1.6;References;218
10.4;Chapter 20;222
10.4.1;Pain in Sickle Cell Disease;222
10.4.1.1;Introduction;222
10.4.1.2;1. Disease Pathophysiology;223
10.4.1.3;2. Clinical Characteristics of Vaso-Occlusive Pain;224
10.4.1.4;3. Other Pain Syndromes;225
10.4.1.4.1;3.1. Chest Pain;225
10.4.1.4.2;3.2. Headache;225
10.4.1.4.3;3.3. Abdominal Pain;225
10.4.1.4.4;3.4. Avascular Necrosis;226
10.4.1.5;4. Pain Treatment in the Home Setting;226
10.4.1.6;5. Pain Treatment in the ED;226
10.4.1.7;6. Pain Treatment in the Hospital Setting;227
10.4.1.8;7. Closing Thoughts;227
10.4.1.9;Take-Home Points;227
10.4.1.10;References;228
10.5;Chapter 21;230
10.5.1;Chronic Pelvic Pain;230
10.5.1.1;Introduction;230
10.5.1.2;1. Evaluation;230
10.5.1.2.1;1.1. History;230
10.5.1.2.2;1.2. Physical Exam;230
10.5.1.2.3;1.3. Testing;231
10.5.1.3;2. Primary Dysmenorrhea;231
10.5.1.4;3. Endometriosis;231
10.5.1.5;4. Irritable Bowel Syndrome;232
10.5.1.6;5. Musculoskeletal Pain;233
10.5.1.7;6. Interstitial Cystitis;233
10.5.1.8;7. Pediatric Pain Center: A Multidisciplinary Approach;234
10.5.1.8.1;7.1. Pharmacologic Therapies;234
10.5.1.8.1.1;7.1.1. Antidepressants;234
10.5.1.8.1.2;7.1.2. Anticonvulsants;235
10.5.1.8.1.3;7.1.3. Tramadol;235
10.5.1.8.2;7.2. Cognitive-Behavioral Therapy;235
10.5.1.8.3;7.3. Physical Therapy;236
10.5.1.8.4;7.4. Complementary and Alternative Medicines (CAM);236
10.5.1.9;Take-Home Points;236
10.5.1.10;References;236
10.6;Chapter 22;240
10.6.1;Palliative Care for the Pediatrician;240
10.6.1.1;Introduction;240
10.6.1.2;1. Epidemiology;240
10.6.1.3;2. Definition of Palliative Care;241
10.6.1.3.1;2.1. Essential Elements of Pediatric Palliative Care;241
10.6.1.4;3. Identifying Children Who Might Benefit from Palliative Care;241
10.6.1.5;4. The Role of the Primary Care Physician;242
10.6.1.5.1;4.1. Communication;242
10.6.1.5.2;4.2. Coordination of Care;243
10.6.1.5.3;4.3. Respite Care;243
10.6.1.6;5. End-of-Life Issues;243
10.6.1.6.1;5.1. Grief and Bereavement;243
10.6.1.6.2;5.2. Complicated Grief;244
10.6.1.7;6. Pain and Symptom Management;245
10.6.1.7.1;6.1. Pain;246
10.6.1.7.1.1;6.1.1. Initiating Therapy;246
10.6.1.7.1.2;6.1.2. Neonates;246
10.6.1.7.2;6.2. Opioid Side Effects;247
10.6.1.7.2.1;6.2.1. Idiosyncratic Reactions;247
10.6.1.7.2.2;6.2.2. Opioid Rotation;247
10.6.1.7.3;6.3. Progressing Pain;248
10.6.1.7.3.1;6.3.1. Intractable Pain;248
10.6.1.7.3.2;6.3.2. Total Analgesia;248
10.6.1.7.4;6.4. Dyspnea;248
10.6.1.7.5;6.5. Nausea and Vomiting;249
10.6.1.7.6;6.6. Seizures;249
10.6.1.8;Take-Home Points;249
10.6.1.9;References;249
11;Part V: Special Topics;252
11.1;Chapter 23;254
11.1.1;Labeling of Pediatric Pain Medications;254
11.1.1.1;Introduction;254
11.1.1.2;1. Important Lessons from Pediatric Studies;256
11.1.1.2.1;1.1. Pharmacokinetics;256
11.1.1.2.2;1.2. Efficacy;256
11.1.1.2.3;1.3. Safety;257
11.1.1.3;2. Regulatory Highlights;257
11.1.1.4;3. FDA-Approved Labeling;257
11.1.1.5;4. Special Topics: DEA Regulations;259
11.1.1.6;5. Pediatric Labeling for Drugs Commonly Used For Analgesia or Anesthesia as of December 2006;260
11.1.1.6.1;5.1. Acute Pain;260
11.1.1.6.1.1;5.1.1. Acetaminophen, Aspirin, and Nonsteroidal Agents;260
11.1.1.6.1.2;5.1.2. Opioids;273
11.1.1.6.1.3;5.1.3. Epidurals;273
11.1.1.6.1.4;5.1.4. Local Anesthesia;274
11.1.1.6.1.5;5.1.5. Topical Anesthesia;274
11.1.1.6.2;5.2. Chronic Pain;274
11.1.1.6.3;5.3. Headaches;274
11.1.1.6.4;5.4. Muscle Relaxants;274
11.1.1.7;6. Gaps in Labeling;275
11.1.1.8;Take-Home Points;275
11.1.1.9;Resources;276
11.1.1.10;References;276
11.2;Chapter 24;278
11.2.1;Pediatrician as Advocate;278
11.2.1.1;Introduction;278
11.2.1.2;1. Barriers to Pain Advocacy in Primary Care;279
11.2.1.3;2. Physician as Advocate;280
11.2.1.4;3. The Importance of the Message;280
11.2.1.5;4. Developing Your Message;281
11.2.1.6;5. Story Telling;281
11.2.1.7;6. Goal and a Plan of Action: Advocating for Kids’ Pain Outside of the Exam Room;283
11.2.1.8;Take-Home Points;284
11.2.1.9;References;284
11.3;Chapter 25;286
11.3.1;Conclusion: What to Do When There is Nothing to Do;286
11.3.1.1;Introduction;286
11.3.1.2;1. There is Always Something to Offer;286
11.3.1.3;2. There is Always Something to Do (at Least by the Patient);287
11.3.1.4;3. FDA Approval and Medication Use;287
11.3.1.5;4. Looking Ahead;289
11.3.1.6;5. "Good Luck";289
11.3.1.7;Final Take-Home Points;290
12;Index;292