Wynn-Jones P, Anderson C T
Nurse Anesth. 1992 Sep;3(3):103-9.
Historically, pain in ill and injured pediatric patients has not been recognized or attended to. Subsequently, children often suffer in silence. Caretakers are often fearful to intervene aggressively to alleviate pain. A critical evaluation and integrative approach to the treatment of pediatric pain has only recently emerged, and curricula addressing the physiologic, behavioral, and biochemical differences related to pain has only recently been instituted in some medical schools and pediatric training programs. Children deserve special consideration in pain management since they may not be capable of comprehending the need for painful procedures and may not have learned strategies to cope with them. The importance of a comprehensive evaluation can not be overstated. The anesthetist can be of great assistance in pain management of the pediatric surgical patient by assessing his patient's postoperative pain needs and planning his/her anesthetic technique and recovery room course accordingly. Research in pediatric pain is still in its infancy, with crucial issues yet to be addressed. One of the most important is how to individualize the treatment of pain. We also need to learn more about children's natural coping styles and how parents and health care providers can enhance their effectiveness in contributing to the therapeutic team. It is hoped that readers will notice their patient's behaviors a little more closely, think about the extent of their private suffering, and become willing to offer a more studied, justifiable, and aggressive approach to pediatric pain management.
从历史上看，患病和受伤的儿科患者的疼痛一直未得到认识或关注。因此，孩子们常常默默忍受痛苦。照顾者往往不敢积极干预以减轻疼痛。一种对儿科疼痛治疗的批判性评估和综合方法直到最近才出现，并且在一些医学院校和儿科培训项目中，针对与疼痛相关的生理、行为和生化差异的课程也只是最近才设立。在疼痛管理中，儿童值得特别考虑，因为他们可能无法理解痛苦程序的必要性，也可能尚未学会应对这些程序的策略。全面评估的重要性再怎么强调也不为过。麻醉师通过评估患者术后的疼痛需求，并相应地规划其麻醉技术和恢复室流程，可以在儿科手术患者的疼痛管理中提供很大帮助。儿科疼痛研究仍处于起步阶段，关键问题尚待解决。其中最重要的一个问题是如何使疼痛治疗个体化。我们还需要更多地了解儿童的自然应对方式，以及父母和医疗保健提供者如何提高他们在治疗团队中的作用效果。希望读者能更密切地留意患者的行为，思考他们内心痛苦的程度，并愿意为儿科疼痛管理提供更深入研究、合理且积极的方法。
