Eight health professionals have created an association Dolor.in (Little pains) that has got as main objectives concienciation of the underdiagnosis and déficitary attention towards pain in children.

Eight professional’s women related to the health wellbeing have created a group of work to improve the approach and education to children pain, not only pain due to procedures but also chronic pain. The association Dolor.in is conformed by an anesthetist, a pediatrician, a nurse, a psychoeduacational specialist, a psychologist 2 PT and a hospitalary pharmacist, they have come to suffer the underdiagnosis of pain and the lack of attention in their daily activities, so they have started to work to increase the sensibilization and the need of multidisciplinary treatment. The group of work has got Twitter (“dolor_in) and is organizing different activities like an itinerary exposition of pictures of pain drawn by children that express their pain, between them.

Our model could be Boston Children Hospital, in USA one of the pioneering centers that got different pain units (chronic, Head, abdominal, etc.) one of the initiatives in the Comfort Project to reduce children pain due to needles, specially pain produces by any procedure that uses needles, including vaccinations. Due to this reason sometimes children are not vaccinated.

Till Boston travelled Tania Garcia specialist in Anesthetist at Hospital Quiron SL Valencia who wants to extrapolate this multidisciplinary Project at the health centers of Valencia and the rest of hospitals in Spain. The Comfort Project is based in four “easy techniques”, as the doctor explains:

• Insensibilization: the skin should not feel pain that needle produces when needle gets across skin tissue, this way, local anesthetics should be used between another methods .
• Maternal breastfeeding or sucrose: if breastfeeding is started between 10-15 minutes before the needle stabbing, the baby reaction is hardly any and doesn´t cry. Happens the sameif given sucrose.
• Distraction measures: could be used different methodologies in accordance with children age, and books, phones and toys are used.
• Help of parents and positioning: The presence of relatives could calm the child, it does also help to keep its blanket, over parent’s knees, holding without restrictions, instead of leaving him over the Surface of a trolley. It is very important parents explain the child what is going to happen and to avoid lies.

Courses and workshops of health professionals

Chus Vidorreta, pediatric nurse from General Hospital in Valencia, she makes input on the educational aspects of the team:” We are going to make a workshop for health professionals, to learn new methods to improve the wellbeing of children, their comfort and welfare”. As she explained there are methods that alleviate this pain to avoid parents to feel uncomfortable and overload when they take their children to vaccination or to receive any procedure.” Some parents even prefer not to vaccinate their children to avoid them the damage of needles something that is a high risk, this nurse has mentioned.

As Chus Vidorreta has told us, the nurses are responsible of the care of the patient: we are in charge of these methods, as well as for the blood test and invasive tests. It is a main need to have enough knowledge to alleviate acute pain. We have to educate family and health professionals to support the patients. We are going to create a divulgate so we can tell parents what to do to improve their children health. Sometimes parents feel quite overload about their children pain, and they feel better if they are with them accompanying and specially avoiding comments like: “He is not going to do it well”,” he is going to cry a lot”, etc.

Valoration scales, adapted.

Also Ana Minguez, doctorated in Pharmacy and hospitalary pharmacist at General Hospital in Valencia, she brings to the multidisciplinary team 20 years of hardworking experience in pain in adults and children. She mentions, she is doing a questionnaire in four different health departments in Valencia, Spain (4 hospitals of reference and 12 centers of primary care) 900 children were attended at the external consultations, these questionnaires showed that 13% of children between 6 and 16 years have chronic pain that is not well treated. Most of these patients are long time sufferers, that are not treated neither diagnosed. “We pretend to identify the problem and to quantify the problem to approach it correct way”, Ana Minguez said.

There are scales that valorate pain that have to be adapted to the children age. It is necessary define an adequate treatment taking into account that children are a vulnerable population, as well as its type of pain. ”We want children to learn to come to the hospital in a quiet way, not to have problems and fear to health professionals avoiding generations of traumas”.

As a pharmacist I realize about the problems that exist in children medications as lack of clinical essays, as lots of administrative permits are required. “Adult medication are used in adults adapted to children weight, but that could finish with lower or over dosis. We do not have medications adapted to children pain, and that is a great problem”. In this sense, I have mentioned the use of paracetamol and NSAID´s in children care.” They are medicines that required to be used with care in children.” We have local anesthetics creams, some local anesthetics pads and measures that are not pharmacological. Our medicines for children pain is reduced but there are analgesic methods that could be used.

Taking this into account, Dra Tania García shows that the use of local anesthetic cream, a mixture of two different local anesthetics, lidocaine and prilocaine, and lidocaine 4-5 % clould be applied without risk, even in small children and babies, even though these mixtures take at least one hour to produce its numbing effect.

Unit of pain in children

Between non pharmachological methods the help could be provided by specialist in PT. Patricia Morán and Bibiana Badenes have shown that “the mayor needs are in chronic pain as it last long in time, children do not know how to define it, and they have got fear of moving and doing social activities”.”The big challenge in our team is to create an unit where children and teenagers with acute or chronic pain could find help, as much as their families, as pain is disabilitating”.

We have to help children to learn to cope with pain in case would not be erradicated.” If we manage to feel less pain, we will improve its quality of life. We realize a common evaluation of each patient and from that we organize a multidisciplinary treatment. Says Patricia Moran.

If we go through different health centers and Spanish hospitals, we find out there are hardly units of pediatric pain. Children with pain go from one specialist to another and sometimes they are mentioned to suffer children growing pains, something that exist but sometimes it is not their pain. That is why we claim for creation of children pain units.

The first thing a PT has to do is to find out how long the patient has been with the pain and if it changes along the day. Then you decide if your child will need a more conventional physiotherapy or exercices adapted from yoga or dance, that could reduce pain and stiffness

Within the same ideas work Bibiana Badenes, especialist in Education and Somatic Movement at Center Kinesis (Benicassim Castellon). She feels that it is needed to take into account children body, and its mental health and to see how pain affects them. Learning has different times, therapy, dedication and coaching. Mindfulness could help with the body conscience to cope with pain and stress, it is essential to give our patients and their carers, tools for coping with pain as hydrotherapy, sleep hygiene, relaxation techniques, etc”

Writing and drawing

In the psychological educational enviroment, Pura Alamar has spoken about drawing and writing as communication pathways of children with pain, and she is already preparing didactic material to help parents and children with chronic pain.”We have developed an App “Solete “.With this App we want to help parents and carers to be the best physiotherapist for their children.

In our proyect we develope didactic material , like tales and other psychological techniques to work with the emotions realted to pain. ”I want to accompany with the pain, and allow children to share the feelings that pain produce on them, specially the anxiety and negative thoughts to control it. This way relaxation ,breathing control and different cognitives therapies are very helpful.

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