2/4: Pain Control with Drugs:

Is there any such thing as perfect pain control?

No, some drugs make children feel sick or itchy, they may become constipated, or have strange dreams. Yet when pain is the main problem, ii should be relieved. The side-effects can be reduced by using extra drugs, such as anti-emetics to stop sickness, or by changing the pain control method

Do some children need more pain relief than others?

Yes, there is no such thing as the right standard dose'. The amount is right if it suits that child, and working out the best safe dose is vital.

Pain jargon explained:

Pain-relief drugs: any pills, tablets, medicines, injections, creams, sprays, or suppositories that help reduce pain

Analgesia: mild to moderate pain relief Anaesthetist: doctor who specialises in pain relief

Anaesthetic: pain relief when a child undergoes an operation

Local anaesthesia: given to provide loss of feeling to stop pain in part of the body either by - a special cream or gel rubbed into the skin which dulls or blots out the pain from needles - or by epidural/spinal, a tiny lube fitted near to the spine, through which pain relief can be slowly ted

General anaesthesia: when the child is unconscious and put to sleep and feels no pain, for example during an operation

Anti-emetics: drugs which stop the child feeling, and being sick

Acute: short-term, sudden onset

Chronic: long-term

What are the different options?

EXAMPLES OF PAIN RELIEF DRUGS

For mild pain: Paracetamol; paracetamol suspensions such as Calpol,Tixymol, Disprol. (These are available to buy without prescription in a pharmacy.)

For moderate pain: Codeine, Diclofenac, lbuprofen, lndomethacin, Naproxen

For severe pain: Morphine, Diamorphine, Pethidine

A child who continues being in pain may need to have a higher dose, or to take the drug more often, or to go onto a stronger drug, within safe limits. Valium is used very rarely with other drugs; it reduces anxiety but not pain and some children dislike it. Severe pain needs powerful drugs, and they will not turn your child into a drug addict. Even if they have to take morphine for weeks, children come off it quite easily when the pain goes.

How are these drugs given?

Pills, tablets or medicine by mouth - this is the easiest way (if your child can wait for them to take effect), but relies on him being able, and willing, to eat and drink

IV drip - if your child can't have pills or medicine, he will probably have a drip fixed into a vein. If the ward has the right kind of pump, drugs may be fed in painlessly through the drip, If there isn't a drip, and your child is having long-term treatment for a chronic problem, he might have a central line. This is a needle left in the skin, taped on so that he can't feel it. Drugs can be given through the needle painlessly.

Spinal or Epidural - in a few hospitals, after some major operations, anaesthetists set up an epidural near the spine. They may also give a nerve block' injection - before the child wakes up - which dulls the pain for hours

Other options - some pain is relieved by creams, skin patches, suppositories and nose-sprays.

What about pain-killing injections?

These days relieving pain by injection tends to be avoided, and the methods just mentioned are preferred. In particular, some children's wards no longer use IM (into a muscle) injections as so many children hate them. There are often delays before they are given, and a wait of an hour or more before they work.

What about severe pain?

For severe pain, PCA ( Patient Controlled Analgesia) is very useful. This pain relief drip is timed to give a set dose, very slowly. There is a small button or pump for patients to press when they want or need it - either because their pain is coming on again, before physiotherapy, or when a wound is dressed.

How is long-term pain dealt with?

This Action for Sick Children article is mainly about pain during a short illness or after surgery. If there is long-term pain, doctors and nurses will probably be working with you and your child to control it. If not, perhaps you and your child could talk to the doctor, using some of the points raised in this booklet as a guide. In the meantime, keeping a pain diary can help you to see how much relief is needed, the best times to take it, the triggers' which seem to start off the pain, and how to avoid them.

What about a long-term problem with sudden attacks of pain?

If your child is in pain, such as that associated with sickle cell disease, he should rest, keep warm, have plenty to drink and take paracetamol. If the attack is severe he may have to stay in hospital and have morphine. Your child should be given urgent treatment as soon as he arrives and you should have a card or letter from your doctor explaining what must be done to show to hospital staff.

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