Why Aren’t We Managing Children’s Pain? | New York Times | By Rachel Rabkin Peachman | June 27, 2016
This article points out how the minimization of pain, its impact and its consequences, is embedded in American culture, while any yielding to pain is viewed as weakness, even a character flaw.
The medical field has long rejected pain as a significant component of health, and this has resulted in cases of sadistic cruelty:
As recently as the 1980s, babies would routinely undergo invasive medical procedures, including open-heart surgery, without anesthesia or analgesics because physicians believed that infants’ brains were not developed enough to feel the pain.
And it was thought that even if babies did feel pain, it wouldn’t ultimately matter because they wouldn’t remember it later on.
This flagrant display of self-righteousness combined with the callous trivialization of others’ suffering is a clear abuse of power and has no place in medical care.
This attitude results in the ubiquitous social pressure to be “tough” and “just do it”, demanding that people ignore their pain and proceed as though it did not exist.
It began with a simple roller-skating accident three years ago. Taylor Aschenbrenner, then 8 years old, lost her balance amid a jumble of classmates, tumbled to the floor and felt someone else’s skate roll over her left foot. The searing pain hit her immediately.
The diagnosis, however, would take much longer. An X-ray, M.R.I.s, a CT scan and blood tests over several months revealed no evidence of a break, sprain or other significant problem. Taylor’s primary symptom was pain — so severe that she could not put weight on the foot.
“Our family doctor first told us to give it some time,” said Taylor’s mother, Jodi Aschenbrenner, of Hudson, Wis.
But time didn’t heal the pain. After about a month, an orthopedist recommended physical therapy. That didn’t end the problem, either. “I couldn’t walk or play outside or do anything,” Taylor said.
After she had spent a year and a half on crutches, her orthopedist suggested she see Dr. Stefan Friedrichsdorf, the medical director of pain medicine, palliative care and integrative medicine at Children’s Hospitals and Clinics of Minnesota.
He and his team promptly recognized Taylor’s condition as complex regional pain syndrome, a misfiring within the peripheral and central nervous systems that causes pain signals to go into overdrive and stay turned on even after an initial injury or trauma has healed.
He came up with a treatment plan for Taylor that included cognitive behavioral therapy, physical therapy, mind-body techniques, stress-reduction strategies, topical pain-relief patches and a focus on returning to her normal life and sleep routine, among other things.
“That turned things around so fast, if I didn’t see it myself, I wouldn’t have believed it,” Mrs. Aschenbrenner said. “I thought, ‘finally, someone understands what this is, has experience with it, and knows how to fix it!’”
But why did it take so long for a child in unbearable pain to find relief?
Experts say children’s pain is, for the most part, grossly underrecognized and undertreated.
Veterinary schools require “at least five times more education on how to handle pain” than medical schools, Nora D. Volkow, the director of theNational Institute on Drug Abuse, said earlier this year in testimony before a Senate committee.
As recently as the 1980s, babies would routinely undergo invasive medical procedures, including open-heart surgery, without anesthesia or analgesics because physicians believed that infants’ brains were not developed enough to feel the pain. And it was thought that even if babies did feel pain, it wouldn’t ultimately matter because they wouldn’t remember it later on.
The emphasis in Western medicine has traditionally been on “addressing the underlying condition at hand, saving lives and executing medical procedures effectively, while pain has been pushed way down on the priority list,”
Many doctors and parents also fear that pain medications, whether or not they are warranted, will have dangerous side effects on children, such as developmental problems and addiction.
Current scientific evidence, however, supports a different conclusion.
“Research shows that poorly managed pain exposures early in life can actually change the wiring in the brain and prime children to be more sensitive to it later on, putting them at risk for developing chronic pain in childhood and adulthood,”
And while babies or young children may not consciously remember it later in life, their nervous systems will.
Contrary to previous conventional thinking, the effective use of pain medication for children does not hinder brain development, according to several studies.
“We know that giving strong pain medications to very young children does not interfere with their neurodevelopment later on,” Dr. Friedrichsdorf said.
Research has also shown that the appropriate medical use of prescription pain medications, such as opioids, when properly monitored, does not lead to addiction in young children and adolescents, Dr. Friedrichsdorf added.
A host of other behavioral interventions have been shown to prevent and treat pain as well. Pain experts say these can and should be used even during seemingly minor medical procedures, such as vaccinations.
Parents can hold their children during the procedure, breastfeed or give them a sweet solution (or a lollipop for older children) to suck on, distract them with a song or breathing exercises, and use a topical numbing cream if needed.
“One of the best ways to address the epidemic of chronic pain in this country is to stop it before it starts,” said Dr. Wilson at Oregon Health & Science University. “If we could reduce painful experiences and problems in childhood, we might be able to reduce chronic pain in the next generation.”