Managing chronic pain in children and adolescents

Editor—Eccleston and Malleson point out the “vacuum” of treatment for pain in children during the time required for diagnosis.¹ This lack of attention to pain exists also for children with chronic disorders (such as inflammatory bowel disease, cancer, and rheumatoid arthritis) that often require repeated painful procedures (colonoscopy, lumbar puncture, bone marrow aspiration, arthrocentesis).

The need to perform sedation in children in this setting has increased notably, and deep sedation is required to achieve anxiolysis and immobilisation necessary for painful procedures.² Nevertheless, deep sedation is not routinely offered to children. In Italy no formal guidelines recommend deep sedation for oncological procedures and only the last guidelines of the Italian Society of Pediatric Gastroenterology recommend sedation for endoscopies.³

The lack of availability of anaesthesia resources, the risk of oversedation, and decrease in level of cardiorespiratory function limit the widespread use of this practice. Trials are ongoing to clarify the safety profile of different sedative drugs and to determine the settings in which nonanaesthetists may administer them,⁴ and there is evidence confirming that trained staff can administer sedation safely in designated settings. In our experience, the development of a paediatric sedation unit with trained staff has allowed a notable improvement in the quality of care of patients, increasing the number of procedures performed with significant sparing of resources.⁵ A comprehensive approach to the problem of pain in children cannot avoid addressing this issue and recommendations and guidelines are needed.