Pain management in intellectually disabled children: Assessment, treatment, and translational research

Abstract

The primary focus of pain research in intellectually disabled individuals is still on pain assessment. Several observational pain assessment scales are available, each with its own characteristics, its own target group and its own validated use. Observational studies report differences in the treatment of intra- and postoperative pain of intellectually disabled children and almost all children with intellectual disability have comorbidities that need to be addressed. The scope of research has started to broaden. In this review we aim to answer the question: Can we integrate validated ways of pain assessment and postoperative pain treatment in intellectually disabled children to develop specific analgesic algorithms? Regrettably there is little knowledge on possible interaction effects and other relevant pharmacological issues. Possible genotype-phenotype associations related to pain in children with Down syndrome have several promises as six possible candidate genes are located on chromosome 21. In conclusion, the pain assessment tools for intellectually disabled children are there. We should now focus on tailoring the pain treatment. To this aim we need to perform pharmacokinetic and pharmacodynamic studies of analgesics and obtain information about the genotype-phenotype relationships for pain. This can lead to the development of specific analgesic algorithms.

Objective Assessment of the Immediate Postoperative Analgesia Using Pupillary Reflex Measurement

“…6,7 Lastly, analgesia evaluation is of primary importance in patients having communication impairment, making adequate pain relief quite impossible to provide. 19 Pupillary dilatation in response to a noxious stimulus has been well characterized. 9 -12,20,21 It is considered a reliable index of the adequacy of the analgesic component during a balanced general anesthesia.…”

“…5 Moreover, it has been shown that IMT-induced sedation, which could be associated with residual pain intensity, may prevent an accurate evaluation of the delivered analgesia. 6,7 Lastly, some patients, such as nonverbal or cognitively impaired patients, 8 are unable to adequately express their pain level, making IMT very difficult to implement. In these circumstances, the use of tools to provide objective evaluation of immediate postoperative analgesia and guide IMT would be of valuable help.…”

Pain management in intellectually disabled children: a survey of perceptions and current practices among Dutch anesthesiologists

“…Intellectually disabled children often suffer from conditions that require painful and surgical interventions (5). Several observational pain assessment tools have been developed for these patients as recently reviewed by Voepel-Lewis et al (6) and us (7). Epilepsy is also common and chronic treatment with anticonvulsants may have consequences for anesthetic and postoperative care (8)(9)(10).…”

A comparison of three scales for measuring pain in children with cognitive impairment

“…Observational assessment is the only way to recognise and quantify pain in this subset of patients, and it should be performed with dedicated tools . It is well known that children with cognitive impairment suffer significantly more pain than their typically developing peers .…”