Do no harm--but first, do not hurt

• Published in: Canadian Medical Association journal (CMAJ) 2005-06, Vol.172 (13), p.1699-1699
• Main Author: Pitetti, Raymond D
• Format: Article
• Language: English
• Subjects: Anesthesia, Local; Anesthetics, Local - administration & dosage; Bioethics; Care and treatment; Catheterization, Peripheral - adverse effects; Child; Children; Health aspects; Humans; Infant; Lidocaine; Lidocaine - administration & dosage; Liposomes; Pain; Pain - prevention & control; Pain Measurement
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.050537

Thankfully, we no longer hold to such archaic ideas. Neuroanatomic studies have shown that by 29 weeks of gestation, pain pathways and the cortical and subcortical centres involved in the perception of pain are well developed, as are the neurologic systems for transmitting and modulating painful sensations. Therefore, even fetuses can perceive pain in ways similar to those of an older child.2 In addition, studies have shown that pain and distress, such as that associated with painful procedures, can endure in the memory and result in, for example, disturbances to eating, sleeping and the stability of the state of arousal.3 Finally, pain in children can be assessed through physiologic indicators, systematic observation of behaviour, and reports by the children themselves. As a result, there has been a marked change in the approach to pain and pain management in children. As clinicians caring for children, we should be cognizant of the consequences of our actions. It is clear that children experience pain. Thus, we should make every effort to alleviate or mitigate this pain, especially during painful procedures. [Taddio] and colleagues have shown that the use of a topical anesthetic such as liposomal lidocaine can result in significantly less pain perceived by the child and a higher procedure success rate. In fact, successful anesthesia and analgesia may in some cases obviate the need for procedural sedation. Clinicians have an ethical responsibility-to provide full treatment of pain in children unless otherwise justified by defined therapeutic benefits. The assessment and treatment of pain in children are important aspects of pediatric care, and failure to provide adequate control of pain amounts to substandard and unethical medical practice. Taddio and colleagues have provided us with one more therapeutic option.