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Poorly managed childhood can have lifelong consequences

n Cite as: CMAJ 2019 July 8;191:E771-2. doi: 10.1503/cmaj.109-5768

Posted on cmajnews.com on June 18, 2019.

oes it matter if an feels the tals underwent painful procedures with- is a good example. pinch of an injection? Or if a out appropriate . “Breastfeeding during painful procedures preemie feels the abrasion of a Part of the challenge of pain manage- is not just comforting; science has shown Dfeeding tube? Not so long ago, it was ment in children is communication. that it’s a proven pain reliever,” says widely believed that the very young Many patients are pre-verbal so their Chambers. But sometimes health profes- couldn’t even feel pain. But a new cam- paign is warning that unmanaged pain in early childhood not only hurts, it can have long-lasting undesirable effects and needs to be tackled more effectively. “There’s this belief that pain will toughen you up and you’ll get used to it,” says Christine Chambers, Canada Research Chair in Children’s Pain at Dal- housie University. “But the reverse hap- pens. There’s a lot of science showing sensitization, and that poorly managed pain early in life actually causes you to feel more pain later.” Chambers is spearheading a cam- paign, Solutions for Kids in Pain, dubbed SKIP, which launched in April. It aims to bring together families, clinicians, researchers and health system managers to help ensure children’s pain is managed appropriately. “There is a pretty substantive litera- ture looking at the long-term effects of poorly managed pain in babies, espe- cially preterm babies,” says Chambers. Research suggests unchecked childhood pain can delay healing, alter ­development, lead to chronic pain and increase the risk of addiction later in life. iStock.com/kckate16 Pediatric pain has historically been A campaign to manage pain better in children was recently launched in Canada. managed poorly compared to adult pain, says Chambers. Although we have moved need for pain relief is difficult to assess. sionals discourage it, expressing concern on from the dark days of not even anes- But another part is not translating that babies will start associating eating thetizing babies undergoing surgery, chil- ­scientific findings into practice, says with pain. dren’s pain is still undertreated. A 2011 ­Chambers. “We have solutions that we “There’s not as much emphasis on pain paper in CMAJ, for instance, found that know work to reduce pain, but often they management in kids,” agrees Dr. Deepa two-thirds of children in Canadian hospi- just aren’t used.” Kattail, a pediatric anesthesiologist and

© 2019 Joule Inc. or its licensors CMAJ | JULY 8, 2019 | VOLUME 191 | ISSUE 27 E771 NEWS E772 ment it,” says Chambers, pointing out hands ofpeoplewhocanactuallyimple- the medicalconferences,andinto science out of the medical journals, out of employed whentheyshouldbe. Chambers, buttheyarenotalways have beenshowntomitigatepain,says ation strategies,seatingpositions—all sucrose, distractiontechniques,relax- of practice. levels, andsayingit’soutsidetheirscope cream forfearitwillbeabsorbedattoxic botomists willoftennotuseanesthetic when kidsaresentforbloodwork,phle- Even inchildren’shospitals,Kattailsays, think, overall,peoplearenervous.” “I pain researcheratMcMasterUniversity. “It speakstothechallengesofgetting Breastfeeding, anestheticcream, CMAJ pressure oninstitutionstodotheright as ChildKindInternational,canhelpput Children, agrees that accreditations, such chronic painclinicatTheHospitalforSick administrators’ buy-in.” he says.“Youhavetohospital become partoftheaccreditationprocess, level. Goodpediatricpaincontrolhasto must bemoreengagedatthesystems that hasteamedwithSKIP,hospitals dren’s Healthcare Canada, a nonprofit director ofbusinessdevelopmentatChil- knowledge.” whole generationofkidswhomissouton , 17yearsistoolong.It’sa research tothefrontlinesorpractice.“In that itcantakeaslong17yearstoget Dr. FionaCampbell,directorofthe According toDougMaynard,associate | JULY 8,2019 | VOLUME 191 | ISSUE 27 Alison Motluk,Toronto,Ont. strategy,” saysCampbell. for alongtimetogetnationalpain dying by . “We’ve been pushing chronic painhavedoubletheriskof pain. Wealsoloselives;peoplein year tothedirectandindirectcostsof adian economyloses$60billionevery task force.ShepointsoutthattheCan­ Canadian Pain Society, is cochair of the ter. Campbell,whoispresidentofthe on managingpainandifitcandobet- to investigatehowthecountryisdoing launched theCanadianPainTaskForce agement ingeneral. change how Canada addresses pain man- thing. Butshethinksmoreisneededto In April,thefederalgovernment