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American Pain Society
4700 W Lake Ave
Glenview, IL 60025
David A. Williams, PhD, Department Editor
Gary A. Walco, PhD, Chair
Department editors note: In each issue of APS Bulletin, this column will focus on one of the APS Special Interest Groups (SIGs). Currently, APS has four SIGs: Nursing Issues; Pain in Infants, Children, and Adolescents; Psychosocial Research; and Palliative Care. This issue spotlights the Pain in Infants, Children, and Adolescents SIG.
This is the inaugural year of the Pain in Infants, Children, and Adolescents SIG, and this report summarizes the groups status, accomplishments, and goals. The SIGs founding members strongly believe that a developmental perspective is an essential component in the evaluation and treatment of pain in young patients. We do not consider it reasonable to merely apply the principles and empirical findings derived for adults in a downward fashion to infants and children. Although this opinion may, in some ways, be in opposition to that of other pain specialists, we believe that there is a great deal of room for the integration of both viewpoints.
For example, what predisposing factors (e.g., physiological, psychological, social) might be recognized during childhood that could lead a patient to experience difficulty with chronic pain later in life? These data are rarely gathered in most treatment settings, yet they may have important relevance in prevention and treatment. The concept of a lifespan approach to the assessment and treatment of pain has potential merit and should be explored further (Walco & Harkins, 1999). Thus, while most pain practitioners are not comfortable seeing young children as patients, a great deal may be learned from the integration of developmental factors over the course of childhood, adulthood, and the elderly years.
The Pain in Infants, Children, and Adolescents SIG began as a task force in 1995, and one of the first tasks it undertook was to publish a policy statement on the management of acute pain in children. Although some guidelines on pain treatment for children had been available (e.g., Agency for Health Care Policy and Research), there were no published treatment standards delineating the minimally acceptable practice. Members of the task force, which included Marion Broome, RN PhD (nursing), Neil Schechter, MD (pediatrics), Barbara Shapiro, MD (pediatrics), Maureen Strafford, MD (anesthesiology), Lonnie Zeltzer, MD (pediatrics), and Gary Walco, PhD, chair (psychology), thus wrote a policy statement, "The Assessment and Management of Acute Pain in Infants, Children and Adolescents," which was approved by the APS Board of Directors in 1996. To ensure widespread dissemination and recognition of the statement, we sought to issue it conjointly with the American Academy of Pediatrics (AAP). With the assistance of Anthony Richstmeier, MD, it was sent through the APS pipeline via the committee on psychosocial aspects of child and family health. After three rounds of review by a myriad of committees within the AAP, it appears that the statement will, in fact, be published and distributed later this year. Contact Dr. Walco to obtain preprinted versions of the statement in its present form.
Another major goal of the task force was to increase the representation of pediatric pain in the recently released fourth edition of APS's Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. Mitchell Max, MD, and Richard Payne, MD, had sought and incorporated our input in the preparation of the book. We look forward to contributing to future APS projects.
Since we became a SIG, our membership has grown, as have our aspirations. At the annual scientific meeting in November 1998, we formulated several goals. Given that communication is key to any organized endeavor, we agreed to implement an electronic mailing list service (LISTSERV) for APS members that will highlight pediatric pain. The implementation has been completed, and the site is located at http://www.aps-pedsig@home.ease .lsoft.com. We hope to use the LISTSERV to facilitate communication, especially about research related to pediatric pain. We are also exploring the possibility of the SIG having pages on the main APS Web site (http://www.ampainsoc.org/) and we hope to make our material available on the APS Web site in the near future.
Another goal of the SIG is to develop a policy statement addressing chronic pain in children and adolescents. We hope we have learned some lessons from our previous collaboration with the AAP, and that the process will go much more rapidly than it did in 1996. Brenda Bursch, PhD, has agreed to lead this project, and she will soon organize a group to produce the document. Further details will become available as the project progresses.
Our other objectives are less clearly defined at present. We want very much to advocate for better pain management for children, and we may follow several different avenues in accomplishing this goal. For example, we have discussed linking up with other organizations interested in pain and palliative care for children to promote educational and advocacy endeavors. We also plan to explore ways to disseminate information about pain and pain management on a broader level to parents. A great deal can be accomplished to help change practice approaches if consumers increase their awareness and assertiveness.
In summary, we believe that much can be done to promote the field of pain management for children. Although some of these endeavors may take us away from the mainstream of APS activities, we truly seek a greater integration with other pain specialists as well as with consumers. The lessons we have learned from working with children almost certainly have major implications for the pain problems found in adults. The flow of information between pediatric professionals and pain specialists should be bidirectional, so that we can learn from each other.
Agency for Health Care Policy and Research. (1992). Acute pain management: Operative or medical procedures and trauma (Clinical Practice Guideline No.1) (AHCPR Publication No. 92-0032). Rockville, MD: U.S. Department of Health and Human Services.
Walco, G.A., & Hawkins, S. (1999). Life-span developmental approaches to pain. In R.J. Gatchel & D.C. Turk (Eds.), Psychosocial factors in pain: Critical perspectives. (pp. 107-117). New York: Guilford Publications.
Gary Walco is associate professor of pediatrics, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, and chief, section of pediatric psychology, Tomorrows Childrens Institute, Hackensack University Medical Center, Hackensack, NJ.
