The assessment and management of chronic pain in children.

Chronic pain in children and adolescents is frequently misdiagnosed by caregivers. It is not treated until it results in the loss of routine ability and function. Chronic pain is often associated with underlying diseases commonly seen in childhood, including sickle cell disease, malignancy, rheumatologic disorders, inflammatory bowel disease, trauma, and states where there is no identifiable etiology. Chronic pain differs from acute pain in that it serves no useful function. Untreated or under-treated chronic pain will result in the unnecessary suffering of the patient, disruption of family routine, and cohesiveness and restriction of the child's daily activities, thereby increasing long-term disability. Accurate and repeated assessment of chronic pain is required for therapy to be effective. Assessment of chronic pain in children is difficult due to their developing cognitive abilities. The assessment of childhood pain varies with the child's age, type of pain, situation, and prior painful experiences. Assessment tools such as the Varni-Thompson Pediatric Pain Questionnaire and the Visual Analog Scale are helpful for both the patient and physician in helping to identify situations that precipitate pain, to rate the level of pain and determine if therapy has been effective. Documentation of pain assessments and the effectiveness of interventions in the medical record should be included as a routine part of all patient records. Most caregivers have extensive experience in the treatment of acute pain in children but are often not comfortable with the management of complicated and chronic pain states. The therapy for chronic pain in children is multifactorial. It can include agents from multiple classes of pharmacologic agents (nonsteroidal anti-inflammatory drugs, opioids, tricyclic antidepressants, and antineuroleptics) nonconventional therapies (acupuncture and pressure and aromatherapy), as well as herbal and homeopathic remedies.