1 40 2 Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month November 2017 List Notes 1098-4275 Hauer, Julie Houtrow, Amy J Section on hospice and palliative medicine, council on children with disabilities Journal Article Review United States Pediatrics. 2017 Jun;139(6). pii: e20171002. doi: 10.1542/peds.2017-1002. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System Publisher An entity responsible for making the resource available Pediatrics Date A point or period of time associated with an event in the lifecycle of the resource 2017 Subject The topic of the resource Analgesics/ Therapeutic Use; Autistic Disorder/ Complications; Benzodiazepines/therapeutic Use; Cerebral Palsy/ Complications; Child; Conflicts Of Interest To Disclose.; Drug Therapy Combination; Humans; Intellectual Disability/ Complications; Pain/complications/diagnosis/ Drug Therapy; Pain Management/ Methods; Pain Measurement/ Methods Creator An entity primarily responsible for making the resource Hauer J; Houtrow AJ Description An account of the resource Pain is a frequent and significant problem for children with impairment of the central nervous system, with the highest frequency and severity occurring in children with the greatest impairment. Despite the significance of the problem, this population remains vulnerable to underrecognition and undertreatment of pain. Barriers to treatment may include uncertainty in identifying pain along with limited experience and fear with the use of medications for pain treatment. Behavioral pain-assessment tools are reviewed in this clinical report, along with other strategies for monitoring pain after an intervention. Sources of pain in this population include acute-onset pain attributable to tissue injury or inflammation resulting in nociceptive pain, with pain then expected to resolve after treatment directed at the source. Other sources can result in chronic intermittent pain that, for many, occurs on a weekly to daily basis, commonly attributed to gastroesophageal reflux, spasticity, and hip subluxation. Most challenging are pain sources attributable to the impaired central nervous system, requiring empirical medication trials directed at causes that cannot be identified by diagnostic tests, such as central neuropathic pain. Interventions reviewed include integrative therapies and medications, such as gabapentinoids, tricyclic antidepressants, alpha-agonists, and opioids. This clinical report aims to address, with evidence-based guidance, the inherent challenges with the goal to improve comfort throughout life in this vulnerable group of children. Identifier An unambiguous reference to the resource within a given context 10.1542/peds.2017-1002 Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). 2017 Analgesics/ Therapeutic Use Autistic Disorder/ Complications Benzodiazepines/therapeutic Use Cerebral Palsy/ Complications Child Conflicts Of Interest To Disclose. Drug Therapy Combination Hauer J Houtrow AJ Humans Intellectual Disability/ Complications November 2017 List Pain Management/ Methods Pain Measurement/ Methods Pain/complications/diagnosis/ Drug Therapy Pediatrics Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource PedPalASCNet Member Publications Subject The topic of the resource A collection of relevant articles published by one or more of PedPalASCNet's members Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. URL Address <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805346/" target="_blank" rel="noreferrer">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805346/</a> Notes 1918-1523 Siden, Harold B Carleton, Bruce C Oberlander, Tim F Clinical Trial Journal Article Research Support, Non-U.S. Gov't United States Pain Res Manag. 2013 Sep-Oct;18(5):243-8. Epub 2013 Jul 24. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Date A point or period of time associated with an event in the lifecycle of the resource 2013 Title A name given to the resource Physician Variability In Treating Pain And Irritability Of Unknown Origin In Children With Severe Neurological Impairment Publisher An entity responsible for making the resource available Pain Research & Management Subject The topic of the resource Adolescent; Analgesics/ Therapeutic Use; Child; Developmental Disabilities/ Complications; Female; Humans; Male; Pain/complications/ Drug Therapy; Pain Management/ Methods; Pilot Projects; Practice Patterns Physicians'/ Statistics & Numerical Data Creator An entity primarily responsible for making the resource Siden H; Carleton BC; Oberlander TF Description An account of the resource BACKGROUND: Pain and irritability of unknown origin (PIUO) is a challenging problem for nonverbal children with severe neurological impairments. PIUO is not associated with an identifiable source of nociceptive-inflammatory or neuropathic pain. OBJECTIVE: To assess how physicians use pharmacotherapy to treat PIUO, and to report a pilot study of a standardized approach to investigating and treating PIUO. METHOD: Part 1 of the present study involved independently presenting a case vignette of a patient with PIUO to six experienced physicians who care for children with neurological impairments. They were asked for medication choices and sequences to empirically treat PIUO. Part 2 was a pilot study of a PIUO protocol. Patients followed a standard pathway for PIUO, referred to as the pathway for unknown pain (PUP). The initial drug sequence for the PUP was based on Part 1. RESULTS: In Part 1, physicians responding to the case vignette listed eight medications (atypical antipsychotics, benzodiazepines, gabapentin, methadone, opioids, selective serotonin reuptake inhibitors, tramadol and tricylic antidepressants) and eight empiric drug sequences. In Part 2, eight children with PIUO (six to 17 years of age; five females, three males) were enrolled in a pilot clinic. Only two had been fully evaluated for nociceptive-inflammatory pain sources before enrollment. At the end of the pilot study, four patients were clinically improved and only three required a study medication. DISCUSSION AND CONCLUSION: Even experienced physicians do not agree on a common approach for medical treatment of PIUO. A standardized pathway is feasible and readily implemented. The proposed PUP has the potential to address PIUO and be the basis for future intervention studies. Identifier An unambiguous reference to the resource within a given context <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805346/" target="_blank" rel="noreferrer">PMC3805346/</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). 2013 Adolescent Analgesics/ Therapeutic Use Carleton BC Child Developmental Disabilities/ Complications Female Humans Male Oberlander TF Pain and Irritability Project Pain Management/ Methods Pain Research & Management Pain/complications/ Drug Therapy Physician Variability In Treating Pain And Irritability Of Unknown Origin In Children With Severe Neurological Impairment Pilot Projects Practice Patterns Physicians'/ Statistics & Numerical Data Siden H