Publications
APS Bulletin • Volume 17, Number 1, 2007
Resource Reviews
John D. Loeser, MD, Department Editor
Relieve Your Child’s Chronic Pain: A Doctor’s Program for Easing Headaches, Abdominal Pain, Fibromyalgia, Juvenile Rheumatoid Arthritis, and More
Reviewed by Corrie Anderson, MD
Eliot J. Krane, New York, Fireside Books, 2005. Soft cover, 320 pages, ISBN 0-7432-6203-4, $14.
Relieve Your Child’s Chronic Pain represents the collaborative efforts of Elliot J. Krane, MD, Director of Pain Therapeutics at the Lucile Packard Children’s Hospital on the campus of Stanford University Medical School, and Deborah Mitchell, a medical writer specializing in complementary medicine and nutrition topics. The book is a guide for physicians caring for children who are experiencing some of the more common chronic pain syndromes and diseases associated with chronic pain (e.g., headache, abdominal pain, juvenile rheumatoid arthritis, musculoskeletal pain, sickle cell anemia). The book is more than just an overview of chronic pain in children, offering consistent guidelines on how to assess and manage a child with a debilitating condition. Because of the writing style and abundance of information in the book, I would recommend that any family who has a child dealing with chronic pain read it.
The text is divided into three parts. Part I, “Children and Pain,” helps readers understand pain from a child’s perspective and it also teaches physicians or parents how to explain the phenomenon of pain and its effects on the mind and body in a way that young children can grasp. Part I also provides extensive information about how children at different developmental stages understand pain. The authors offer excellent suggestions to caregivers about how to use the proper language when explaining what happens to a child suffering from chronic pain and they also review developmentally appropriate pain assessment tools. The latter section of Part I includes an informative discussion about multiple pain syndromes such as endometriosis, chronic abdominal pain, and facial pain, their pathophysiology, how they are diagnosed, and how they are treated.
Part II, “A Program to Treat Your Child’s Chronic Pain,” is the most interesting section of the book. Straightforward language and patient examples are used to demonstrate points. The authors expand on information presented in Part I and outline a detailed plan for parents and professionals to locate a pediatric pain specialist for their child or patient. They also examine how pain can affect family dynamics, school performance, and friendships and suggest methods for dealing with the stress caused by chronic pain, integration of the child back into school, and dealing with a child’s friends.
A number of nonpharmacological and pharmacological treatment options are currently available to manage a child’s pain and are included in Part II. Suggestions for choosing the right pediatrician—who is capable of understanding chronic pain and able to guide a family to a successful end-point—are discussed in this section, as is the role of child psychologists specializing in pain management. The text includes several detailed discussions about nonpharmacologic pain interventions, such as biofeedback and acupuncture, that every pediatrician should read. The information about guided imagery and hypnosis is excellent. In addition, the authors point out the risks and benefits of each medication used for treating pain in an objective manner and warn that many of the pharmaceuticals discussed have not been approved for use in children. The more invasive techniques used to treat chronic pain, such as epidural analgesia and sympathetic nerve blocks, are presented in a manner that is understandable and would be appreciated both by pediatricians and families.
Part III addresses a wide variety of questions parents may have about chronic pain and its treatment. Multiple success stories are included in the text to give readers an appreciation of the difficulty of treating chronic pain in children and the gratification that comes with helping families and patients regain function. Overall this is an excellent book on chronic pediatric pain. It is neither pedantic nor pedestrian. I would recommend that it be required reading for medical and nursing students before they are allowed to care for children. I would also recommend that it be in every pediatrician’s library because of its detailed nature and multidisciplinary, multimodal approach to treating a child with chronic pain. As a pediatrician, I appreciate the authors’ holistic approach to the patient and family. As a pediatric pain specialist, I also value the sensitivity that the authors bring to the topic. The great number of references and the list of support groups and organizations are a tremendous resource for families with children who have chronic pain. The only other way to obtain such a comprehensive list would be to click through dozens of Web sites, which is not necessarily possible for all of our patients. I have ordered a copy of the book for every member of my pain team to help them better care for children in pain and would recommend the book to any family with a child dealing with chronic pain.
Dr. Anderson is Professor of Anesthesiology and Adjunct Professor of Pediatrics at the University of Washington in Seattle.