NEWS Poorly managed childhood pain 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 infant feels the tals underwent painful procedures with- Breastfeeding is a good example. pinch of an injection? Or if a out appropriate pain management. “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 brain development, lead to chronic pain and increase the risk of opioid 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 pain researcher at McMaster University. that it can take as long as 17 years to get thing. But she thinks more is needed to “I think, overall, people are nervous.” research to the front lines or practice. “In change how Canada addresses pain man- Even in children’s hospitals, Kattail says, pediatrics, 17 years is too long. It’s a agement in general. when kids are sent for blood work, phle- whole generation of kids who miss out on In April, the federal government botomists will often not use anesthetic knowledge.” launched the Canadian Pain Task Force cream for fear it will be absorbed at toxic According to Doug Maynard, associate to investigate how the country is doing levels, and saying it’s outside their scope director of business development at Chil- on managing pain and if it can do bet- NEWS of practice. dren’s Healthcare Canada, a nonprofit ter. Campbell, who is president of the Breastfeeding, anesthetic cream, that has teamed with SKIP, hospitals Canadian Pain Society, is cochair of the sucrose, distraction techniques, relax- must be more engaged at the systems task force. She points out that the Can- ation strategies, seating positions — all level. Good pediatric pain control has to adian economy loses $60 billion every have been shown to mitigate pain, says become part of the accreditation process, year to the direct and indirect costs of Chambers, but they are not always he says. “You have to have hospital pain. We also lose lives; people in employed when they should be. administrators’ buy-in.” chronic pain have double the risk of “It speaks to the challenges of getting Dr. Fiona Campbell, director of the dying by suicide. “We’ve been pushing science out of the medical journals, out of chronic pain clinic at The Hospital for Sick for a long time to get a national pain the medical conferences, and into the Children, agrees that accreditations, such strategy,” says Campbell. hands of people who can actually imple- as ChildKind International, can help put ment it,” says Chambers, pointing out pressure on institutions to do the right Alison Motluk, Toronto, Ont. E772 CMAJ | JULY 8, 2019 | VOLUME 191 | ISSUE 27 .