Hauer Julie M, Solodiuk Jean C
Boston Children's Hospital , Boston, Massachusetts.
J Palliat Med. 2015 May;18(5):453-6. doi: 10.1089/jpm.2014.0359. Epub 2015 Feb 6.
Children with severe impairment of the central nervous system (CNS) have a high incidence of distressing symptoms, with many experiencing frequent recurrent pain episodes.
The study objective was to describe presenting pain behaviors, daily dose, and response to gabapentin for the management of frequent recurrent pain in this population.
A retrospective analysis was performed with data from 22 children with severe impairment of the CNS residing at a long-term care facility, treated with gabapentin for recurrent pain behaviors. Response was considered significant if the frequency and severity of symptoms decreased by more than 50% as assessed by nursing staff.
Pain behaviors commonly reported included facial grimacing, crying, or moaning. Intermittent increase in muscle tone was identified in 86% (n=19). Gastrointestinal (GI) symptoms occurred in 64% (n=14), including pain localized to the GI tract and vomiting. All were assessed for nociceptive pain sources, many with repeated testing. Most were on medications for spasticity (n=20, 91%) and gastroesophageal reflux disease (GERD) (n=22, 100%) prior to gabapentin use. Of the 22 treated with gabapentin, 21 (91%) had a significant decrease in symptoms. No serious adverse events occurred. The mean gabapentin dose for children five years of age or less (n=11) was 50 mg/kg/day (95% CI 45-56) compared to children older than 11 years (n=11) with a mean dose of 36 mg/kg/day (95% CI 34-38).
Gabapentin appears to be an effective treatment for children with severe impairment of the CNS and recurrent pain behaviors, including intermittent changes in muscle tone. Dosing information can guide treatment trials and future prospective studies.
中枢神经系统（CNS）严重受损的儿童出现令人痛苦症状的发生率很高，许多儿童经常经历反复的疼痛发作。
本研究的目的是描述该人群中反复出现的疼痛行为、每日剂量以及加巴喷丁治疗频繁反复疼痛的疗效。
对居住在长期护理机构的22名中枢神经系统严重受损儿童的数据进行回顾性分析，这些儿童因反复疼痛行为接受加巴喷丁治疗。如果护士评估症状的频率和严重程度降低超过50%，则认为治疗有效。
常见的疼痛行为包括面部 grimacing、哭闹或呻吟。86%（n = 19）的儿童出现肌张力间歇性增加。64%（n = 14）的儿童出现胃肠道（GI）症状，包括胃肠道局部疼痛和呕吐。所有儿童均接受了伤害性疼痛源评估，许多儿童进行了多次检查。大多数儿童在使用加巴喷丁之前就已在服用治疗痉挛的药物（n = 20，91%）和胃食管反流病（GERD）的药物（n = 22，100%）。在接受加巴喷丁治疗的22名儿童中，21名（91%）症状明显减轻。未发生严重不良事件。5岁及以下儿童（n = 11）的加巴喷丁平均剂量为50mg/kg/天（95%CI 45 - 56），而11岁以上儿童（n = 11）的平均剂量为36mg/kg/天（95%CI 34 - 38）。
加巴喷丁似乎是治疗中枢神经系统严重受损且有反复疼痛行为（包括肌张力间歇性变化）儿童的有效药物。剂量信息可为治疗试验和未来的前瞻性研究提供指导。
