A recent commentary (JM Hauer JAMA Pediatrics; 2018. doi: 10.1001/jamapediatrics.2018.1531) addresses a common misconception regarding children with severe neurologic impairment (SNI):
“we don’t think she experiences pain”
She notes that literature since 2002 has challenged this assumption and that this is addressed in a new AAP clinical report as well (Hauer J, Houtrow AJ. Pediatrics 2017; 139: e20171002).
- Children with SNI may have moaning, grimacing, changes in tone/body position in reaction to pain and treatment can make them comfortable.
- “We can never prove that such a child does not feel pain…When parents of children with hydranencephaly were asked whether their child felt pain, 96% indicated yes.”
- Pain can trigger changes in catecholamines, cortisol and stress hormones. “These considerations suggest that untreated chronic pain is more harmful to the well-being of children with SNI than is treatment used for pain.”
- Sometimes no source for pain is identified. This may be related to a CNS etiology (alteration of CNS) and may benefit from treatment.
- “It is time to do away with the question of whether these children feel pain and focus on how we as individuals” identify/consider pain
My take: Reframing this issue is important; pain can occur in children with SNI. At the same time, we have to be careful that some “palliative” measures could paradoxically prolong suffering in some children.
Related blog post: Suffering