Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System


Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System


Hauer J; Houtrow AJ








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


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.


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).

Citation List Month

November 2017 List


Hauer, Julie
Houtrow, Amy J
Section on hospice and palliative medicine, council on children with disabilities
Journal Article
United States
Pediatrics. 2017 Jun;139(6). pii: e20171002. doi: 10.1542/peds.2017-1002.


Hauer J; Houtrow AJ, “Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System,” Pediatric Palliative Care Library, accessed February 23, 2024,