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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In Spain&#44; the protection of the health of the child is recognised as one of the fundamental rights of children&#46; This value started to get established in 1989&#44; when Spain joined other countries in the ratification of the Convention of the Rights of the Child&#46; This has favoured advances in paediatrics and the creation of specific laws aimed at the protection of minors&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The World Health Organization defines health as &#8220;a state of complete physical&#44; mental and social well-being&#8221;&#46; Pain is a medical problem that causes physical suffering with psychological&#44; social and spiritual repercussions&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The presence of pain involves a decrease in well-being and health&#46; In Spain&#44; from the 1950s the field of paediatrics has progressed mainly through the introduction of preventive measures and aetiotropic treatments&#46; Based on the data given in the state of the world&#39;s children reports of the UNICEF&#44; child mortality in Spain has been reduced from 95 to 3 out of every 1000 live births between 1950 and 2017&#46; As has been the case of other European countries&#44; this is a success due to which children born in Spain are more likely to grow in better health compared to most children born in other high-income countries&#46; However&#44; the management of pain and other sources of suffering in children remains in the back burner&#46; Even though pain is considered a medical diagnosis&#44; listed in the International Classification of Diseases&#44; 10th revision &#40;ICD-10&#41; under code R-52&#44; only rarely is it documented in the health records of children that have suffered pain due to disease or medical procedures&#46; As paediatricians&#44; we ought to consider whether we can possibly be treating properly something we are not diagnosing&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is estimated that the prevalence of pain in some areas of health care is high&#58; up to 77&#37; of children managed in paediatric emergency care or inpatient care settings experience pain&#44; and this is mainly happening in paediatric patients that do not have underlying diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> There is evidence that pain is underdiagnosed in certain vulnerable populations&#44; such as children with cerebral palsy&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> children with autism spectrum disorders&#44; cancer&#44; rheumatic diseases&#44; etc&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This issue of <span class="elsevierStyleItalic">Anales de Pediatr&#237;a</span> features 2 studies related to the approach to pain management in situations frequently encountered in paediatric clinical practice&#46; The working group of Dr Nieto Garc&#237;a&#44; concerned with the pain suffered by infants during vaccination&#44; reported a prevalence of moderate to severe pain of 59&#46;4&#37; in the 387 patients included in their prospective study&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> They analysed the effectiveness for pain relief of different nonpharmacological interventions that are inexpensive and easy to implement&#58; breastfeeding&#44; non-nutritive sucking with administration of a 10&#37; dextrose solution and non-nutritive sucking alone&#46; Using the previously validated LLANTO scale for pain measurement&#44; they established that in the groups of infants that received 2 vaccines in a single intervention &#40;those aged 2 months and 6 months&#41;&#44; the patients that were breastfed suffered pain less frequently and that was less severe during vaccination compared to those managed with non-nutritive sucking alone or combined with administration of a 10&#37; dextrose solution&#46; These findings corroborate the effectiveness of breastfeeding for pain management&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The research group led by Dr Toledo conducted a prospective study of children and adolescents &#40;age range&#44; 4&#8211;15 years&#41; admitted to the paediatric ward that required potentially painful invasive procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> They applied a multimodal approach to analgesia based on the delivery of pleasant visual and auditory stimuli &#40;virtual reality headset&#41;&#44; alone or combined with topical administration of local anaesthetics &#40;prilocaine&#47;lidocaine&#41;&#46; Distraction methods like the one used in this study rely on the secretion of noradrenaline by the supraspinal nucleus&#44; which inhibits the nociceptive signals sent from the nociceptor to the spinal cord &#40;descending inhibitory pathway&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Using the Wong Baker rating scale &#40;children aged 4&#8211;7 years&#41; and the visual analogue scale &#40;children aged &#62;7 years&#41;&#44; they established that the use of virtual reality techniques can reduce the severity of the pain experienced by patients&#44; and that these methods are even more effective when combined with the application of topical anaesthetic creams&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The 2 studies we have just described assessed nonpharmacological analgesic methods that are inexpensive and feasible&#44; and evinced their effectiveness in healthy infants and children with acute illness&#44; respectively&#46; The implementation of these techniques in paediatrics would substantially relieve pain in a very high number of children that could either suffer no pain or considerably reduced pain as a result&#46; Adequate pain management not only reduces suffering but also prevents the nociceptive system of each individual to become more sensitive to future pain &#40;the phenomenon of sensitisation&#41;&#46; Therefore&#44; it is essential that all paediatricians and nurses involved in the care of children take steps to prevent and&#47;or minimise the pain produced by the diseases we treat and the procedures we prescribe&#44; which is contingent on the anticipation of pain and&#44; once pain is present&#44; its accurate diagnosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">These articles did not analyse the pain endured by children with chronic diseases&#46; This is probably due to the methodological difficulties involved in conducting research in these patients&#44; for whom most scales have not been validated and who usually have multiple and chronic pains that may make comparisons challenging&#44; among other factors&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">At present&#44; further prospective studies are needed to improve the assessment and management of the most common forms of pain in paediatrics&#44; as well as the most common forms of pain specifically experienced by children suffering chronic conditions that are less prevalent&#46; Being aware of the presence of pain is the first step towards developing an adequate treatment plan&#44; and to facilitate this&#44; a field for the documentation of pain should be included by default in the health records of all patients managed at any care level in the health system&#44; and pain included as a distinct diagnosis&#46;</p></span>"
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Editorial
Diagnosis and management of paediatric pain
Diagnóstico y manejo del dolor pediátrico
Lucia Ortiza,b,
Corresponding author
luciaosr@hotmail.com

Corresponding author.
, Iñigo de Noriegaa
a Unidad de Cuidados Paliativos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
b Grupo Español para el Estudio del Dolor Pediátrico de la Asociación Española de Pediatría
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In Spain&#44; the protection of the health of the child is recognised as one of the fundamental rights of children&#46; This value started to get established in 1989&#44; when Spain joined other countries in the ratification of the Convention of the Rights of the Child&#46; This has favoured advances in paediatrics and the creation of specific laws aimed at the protection of minors&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The World Health Organization defines health as &#8220;a state of complete physical&#44; mental and social well-being&#8221;&#46; Pain is a medical problem that causes physical suffering with psychological&#44; social and spiritual repercussions&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The presence of pain involves a decrease in well-being and health&#46; In Spain&#44; from the 1950s the field of paediatrics has progressed mainly through the introduction of preventive measures and aetiotropic treatments&#46; Based on the data given in the state of the world&#39;s children reports of the UNICEF&#44; child mortality in Spain has been reduced from 95 to 3 out of every 1000 live births between 1950 and 2017&#46; As has been the case of other European countries&#44; this is a success due to which children born in Spain are more likely to grow in better health compared to most children born in other high-income countries&#46; However&#44; the management of pain and other sources of suffering in children remains in the back burner&#46; Even though pain is considered a medical diagnosis&#44; listed in the International Classification of Diseases&#44; 10th revision &#40;ICD-10&#41; under code R-52&#44; only rarely is it documented in the health records of children that have suffered pain due to disease or medical procedures&#46; As paediatricians&#44; we ought to consider whether we can possibly be treating properly something we are not diagnosing&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is estimated that the prevalence of pain in some areas of health care is high&#58; up to 77&#37; of children managed in paediatric emergency care or inpatient care settings experience pain&#44; and this is mainly happening in paediatric patients that do not have underlying diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> There is evidence that pain is underdiagnosed in certain vulnerable populations&#44; such as children with cerebral palsy&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> children with autism spectrum disorders&#44; cancer&#44; rheumatic diseases&#44; etc&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This issue of <span class="elsevierStyleItalic">Anales de Pediatr&#237;a</span> features 2 studies related to the approach to pain management in situations frequently encountered in paediatric clinical practice&#46; The working group of Dr Nieto Garc&#237;a&#44; concerned with the pain suffered by infants during vaccination&#44; reported a prevalence of moderate to severe pain of 59&#46;4&#37; in the 387 patients included in their prospective study&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> They analysed the effectiveness for pain relief of different nonpharmacological interventions that are inexpensive and easy to implement&#58; breastfeeding&#44; non-nutritive sucking with administration of a 10&#37; dextrose solution and non-nutritive sucking alone&#46; Using the previously validated LLANTO scale for pain measurement&#44; they established that in the groups of infants that received 2 vaccines in a single intervention &#40;those aged 2 months and 6 months&#41;&#44; the patients that were breastfed suffered pain less frequently and that was less severe during vaccination compared to those managed with non-nutritive sucking alone or combined with administration of a 10&#37; dextrose solution&#46; These findings corroborate the effectiveness of breastfeeding for pain management&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The research group led by Dr Toledo conducted a prospective study of children and adolescents &#40;age range&#44; 4&#8211;15 years&#41; admitted to the paediatric ward that required potentially painful invasive procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> They applied a multimodal approach to analgesia based on the delivery of pleasant visual and auditory stimuli &#40;virtual reality headset&#41;&#44; alone or combined with topical administration of local anaesthetics &#40;prilocaine&#47;lidocaine&#41;&#46; Distraction methods like the one used in this study rely on the secretion of noradrenaline by the supraspinal nucleus&#44; which inhibits the nociceptive signals sent from the nociceptor to the spinal cord &#40;descending inhibitory pathway&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Using the Wong Baker rating scale &#40;children aged 4&#8211;7 years&#41; and the visual analogue scale &#40;children aged &#62;7 years&#41;&#44; they established that the use of virtual reality techniques can reduce the severity of the pain experienced by patients&#44; and that these methods are even more effective when combined with the application of topical anaesthetic creams&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The 2 studies we have just described assessed nonpharmacological analgesic methods that are inexpensive and feasible&#44; and evinced their effectiveness in healthy infants and children with acute illness&#44; respectively&#46; The implementation of these techniques in paediatrics would substantially relieve pain in a very high number of children that could either suffer no pain or considerably reduced pain as a result&#46; Adequate pain management not only reduces suffering but also prevents the nociceptive system of each individual to become more sensitive to future pain &#40;the phenomenon of sensitisation&#41;&#46; Therefore&#44; it is essential that all paediatricians and nurses involved in the care of children take steps to prevent and&#47;or minimise the pain produced by the diseases we treat and the procedures we prescribe&#44; which is contingent on the anticipation of pain and&#44; once pain is present&#44; its accurate diagnosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">These articles did not analyse the pain endured by children with chronic diseases&#46; This is probably due to the methodological difficulties involved in conducting research in these patients&#44; for whom most scales have not been validated and who usually have multiple and chronic pains that may make comparisons challenging&#44; among other factors&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">At present&#44; further prospective studies are needed to improve the assessment and management of the most common forms of pain in paediatrics&#44; as well as the most common forms of pain specifically experienced by children suffering chronic conditions that are less prevalent&#46; Being aware of the presence of pain is the first step towards developing an adequate treatment plan&#44; and to facilitate this&#44; a field for the documentation of pain should be included by default in the health records of all patients managed at any care level in the health system&#44; and pain included as a distinct diagnosis&#46;</p></span>"
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Article information
ISSN: 23412879
Original language: English
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