- Pain assessment using the r-FLACC scale in young children with paralytic syndromes
Pain assessment using the r-FLACC scale in young children with paralytic syndromes
INTERNATIONAL JOURNAL REHABLITATION AND PALLIATIVE MEDICINE.2017.1-2(5-6):69-73; doi 10.15574/IJRPM.2017.5-6.69
Riga О. O., Gonchar М. O., Konovalova N.M., N.V. Orlova
Kharkiv National Medical University, Ukraine
Objective: to assess the pain level in nonverbal young children with paralytic syndromes III–V according to the GMF gradation.
Material and methods. Pain evaluation was performed in 60 nonverbal infants (43 boys and 17 girls) with paralytic syndromes using the r-FLACC behavioral scale. The scale is chosen according to children’s age and cognitive status. It was assumed that in children with paralytic syndromes there was a neuropathic nature of pain due to spastic muscular disorders and central nervous system damage.
Results. According to the study it was determined that “moderate pain” was registered in 30% of children, “severe pain” was observed in 3.3% cases, which required medication and non-medication correction.
Conclusions. The use of an objective instrument for pain assessment in nonverbal young children with paralytic syndromes improved pain syndrome diagnosis in such patients and made it possible to optimize the therapeutic approach.
Key words: pain, children, r-FLACC scale.
1. Chronic Abdominal Pain in Childhood: Diagnosis and Management. Retrieved from American Academy of Family Physicians. http://www.aafp.org/afp/990401ap/1823.html.
2. McGrath PJ et al. (2008). Core outcome domain and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. The Journal of Pain. 9: 771–783. https://doi.org/10.1016/j.jpain.2008.04.007; PMid:18562251
3. Weaver MS, Heinze KE, Bell CJ, Wiener L. (2016). Establishing psychosocial palliative care standards for children and adolescents with cancer and their families: An integrative review. Palliat Med. 30(3): 212–223. https://doi.org/10.1177/0269216315583446; PMid:25921709 PMCid:PMC4624613
4. Gross Motor Function Classification System for Cerebral Palsy. https://depts.washington.edu/dbpeds/Screening%20Tools/GMFCS-ER.pdf
5. Haanpää M, Treede F-D. (2010). Diagnosis and classification of neuropathic pain. IASP Clinical Updates. 18: 1–6.
6. Hauer J. (2010). Identifying and managing sources of pain and distress in children with neurological impairment. Pediatr Ann. 39: 198. https://doi.org/10.3928/00904481-20100318-04; PMid:20411897
7. Ingelmo PM, Fumagalli R. (2004). Neuropathic pain in children. Minerva Anestesiologica. 70: 393–398. PMid:15181421
8. Goddard JM. (2014). Chronic pain in Children and Young People. Pediatrics and Child Health. 24; 2: 89–91. https://doi.org/10.1016/j.paed.2013.08.005
9. Michelson KN, Steinhorn DM. (2007). Pediatric End-of-Life Issues and Palliative Care. Clin. Pediatr Emerg Med. 8(3): 212–219. https://doi.org/10.1016/j.cpem.2007.06.006; PMid:18438449 PMCid:PMC2344130
10. Mathews L. (2011). Pain in Children: Neglected, Unaddressed and Mismanaged. Indian J. Palliat. Care. 17: 70–73. https://doi.org/10.4103/0973-1075.76247
11. Walco GA et al. (2010). Neuropathic pain in children: special considerations. Mayo Clinic Proceedings. 85; Suppl 3: 33–41. https://doi.org/10.4065/mcp.2009.0647; PMid:20194147 PMCid:PMC2844006
12. O’Malley P. (2006). American Academy of Pediatrics Committee on Pediatric Emergency Medicine. Patient- and family-centered care and the role of the emergency physician providing care to a child in the cmergency department. Pediatrics. 118(5): 2242–2246. https://doi.org/10.1542/peds.2006-2588; PMid:17079599
13. Vedula SS et al. (2009). Outcome reporting in industry-sponsored trials of gabapentin for off-label use. The New England Journal of Medicine. 361: 1963–1971. https://doi.org/10.1056/NEJMsa0906126; PMid:19907043
14. Hofman M et al. (2007). Posttraumatic stress disorder in children affected by sickle-cell disease and their parents. American Journal of Hematology. 82: 171–172. https://doi.org/10.1002/ajh.20722; PMid:16924639
15. Saarto T, Wiffen PJ. (2007). Antidepressants for neuropathic pain. Cochrane Database of Systematic Reviews. 4: CD005454. https://doi.org/10.1002/14651858.CD005454.pub2
16. Hetrick SE et al. (2007). Selective serotonin reuptake inhibitors for depressive disorders in children and adolescents. Cochrane Database of Systematic Reviews. 3: CD004851. Organization, 2008 WHO Technical Report Series, No. 950.
17. Stinson J, Nasser B. (2003). Pain management in children with sickle cell disease. Pediatric Drugs. 5: 229–241. https://doi.org/10.2165/00128072-200305040-00003; PMid:12662119
18. WHO model formulary for children. (2010). Geneva: World Health Organization.