What myths have complicated the management of childrens pain?
Research indicates knowledge regarding children’s pain has improved and the myths, like “infants have immature nervous systems and do not feel pain,” have been dispelled. However, attitudes regarding children’s pain have not changed. For example, despite documented knowledge that developmentally appropriate children over 3 to 4 years of age can accurately report pain intensity, health care providers and parents are more likely to believe and attend to behaviors when children’s behaviors are inconsistent with children’s self-reports of pain. Children’s reports of pain are not believed. Adverse effects of pain are discounted, and the adverse effects of pain treatments are overestimated. Thus inappropriate attitudes and concerns regarding pain perpetuate the underrecognition and undertreatment of children’s pain.
Children are typically regarded as resilient, but children can become significantly disabled by recurrent, persistent, and chronic pain. When the protective behaviors appropriate for acute disease or trauma pain persist, it can lead to progressive loss of function. Children and parents need to understand that when significant disability is present, the pain diagnosis and disability must both be addressed. Parents require assistance understanding that the treatment of chronic pain is different from that of pain due to disease or trauma. Opioids are rarely used to treat children’s recurrent, persistent, and chronic pain, and gradual return to activity is encouraged despite pain. Chronic pain affects the entire family, and the emotional suffering, impaired physical function, decreased independence, and uncertain prognosis must be addressed as a family. Children and parents of children with chronic pain require more specialized therapy to return to school and physical and social activities.