Avez-Couturier J, Joriot S, Peudenier S, Juzeau D
Service de neuropédiatrie, CHU de Lille, rue du Pr-Émile-Laine, 59000 Lille, France; Consultation douleur enfant, CHU de Lille, rue du Pr-Émile Laine, 59000 Lille, France; CIC-IT 1403, Maison régionale de la recherche clinique, hôpital universitaire de Lille, CHU de Lille, 6, rue du Professeur-Laguesse, 59000 Lille, France.
Service de neuropédiatrie, CHU de Lille, rue du Pr-Émile-Laine, 59000 Lille, France.
Arch Pediatr. 2018 Jan;25(1):55-62. doi: 10.1016/j.arcped.2017.11.012. Epub 2017 Dec 19.
Management of pain is one of the major expectations of children with neurological impairment and their families. The medical literature is poor on this topic accounting for approximately 0.15 % of the publications on pain in general. The objective of the French Pediatric Neurology Society was to review the current knowledge on this topic. Bibliographic research was conducted with PubMed and RefDoc for publications between 1994 and 2014 in French or English. A total of 925 articles were retrieved and 92 were selected for review. Pain is common in this population: a 2-week survey indicated that pain occurs in 50-75 % of children. Pain negatively impacts the quality of life of children and their parents. Children with neurological impairment express their pain with pain expression patterns and specific patterns common to children (change of tone, abnormal movements, spasticity, paradoxical reactions, such as laughter, self-injury or vasomotor dysfunction). Some children with neurological impairment are able to use self-report pain scales. If not, observational measures should be used. Behavioral rating scales specifically designed for this population are more sensitive than others. Scales must be selected according to children's communication skills, type of pain, and the context. Sometimes behavioral changes are the only expression of pain: any change in sleep, tone, feeding, or mood must suggest pain in this population. Management of pain remains difficult. There are no specific guidelines. Procedural pain management guidelines and the usual analgesic drugs can be used in children with neurological impairment with specific concerns regarding tolerance and side effects. These children are particularly at risk for neuropathic pain. A multidisciplinary approach is helpful, involving physicians, nurses, physiotherapists, psychologists and parents.
疼痛管理是神经功能障碍儿童及其家庭的主要期望之一。关于这一主题的医学文献较少，仅占一般疼痛相关出版物的约0.15%。法国儿科学会的目标是回顾该主题的现有知识。通过PubMed和RefDoc进行文献检索，查找1994年至2014年间法语或英语的出版物。共检索到925篇文章，其中92篇被选中进行综述。疼痛在这一群体中很常见：一项为期2周的调查表明，50%-75%的儿童会出现疼痛。疼痛对儿童及其父母的生活质量有负面影响。神经功能障碍儿童通过疼痛表达模式以及儿童常见的特定模式（音调变化、异常动作、痉挛、矛盾反应，如大笑、自我伤害或血管运动功能障碍）来表达疼痛。一些神经功能障碍儿童能够使用自我报告疼痛量表。如果不能使用，则应采用观察性测量方法。专门为该群体设计的行为评定量表比其他量表更敏感。必须根据儿童的沟通能力、疼痛类型和情境选择量表。有时行为改变是疼痛的唯一表现：睡眠、音调、进食或情绪的任何变化都可能提示该群体存在疼痛。疼痛管理仍然困难。没有具体的指南。程序性疼痛管理指南和常用的镇痛药可用于神经功能障碍儿童，但要特别关注耐受性和副作用。这些儿童尤其容易患神经性疼痛。多学科方法会有所帮助，涉及医生、护士、物理治疗师、心理学家和家长。
