Book Review

Acute and Procedure Pain in Infants and Children

N Engl J Med 2002; 347:455-456August 8, 2002

Article

Acute and Procedure Pain in Infants and Children
(Progress in Pain Research and Management. Vol. 20.) Edited by G. Allen Finley and Patrick J. McGrath. 183 pp., illustrated. Seattle, International Association for the Study of Pain, 2001. $70. ISBN: 0-931092-39-6

This book is based on presentations at the third biennial International Forum on Pediatric Pain, held at White Point Beach, Nova Scotia, Canada, in September 2000. It covers topics ranging from hyperalgesia and allodynia models in rat pups to pain management in infants, children, and adolescents. It also includes a discussion of the “politics of pediatric pain” and how we might achieve the goal of a “pain-free hospital.”

As noted by the contributors, this book is not meant to be a guide for pain relief in pediatrics. The technical skills required to administer many of the analgesic and anaesthetic interventions discussed in this book have to be taught in the clinical setting by someone who is not only technically proficient but also sensitive to the special needs of children and their families. The authors provide good examples of how the best available evidence from basic science, from randomized, controlled clinical trials, and from other high-quality studies can be applied to individual patients. Physicians who can apply this evidence in a clinical setting and who have insight into and empathy for the special needs of sick children are likely not just to reduce pain but also to increase satisfaction with care, even if pain cannot be totally avoided.

As I read this book, I noted considerable overlap among the chapters. Reference is often made to the same publications, but individual authors interpret the information differently. This applies particularly to the literature on how painful experiences during the neonatal period affect short-term and long-term responses to pain. It appears to me that most authors think that there is a clear association between early painful stimuli and an exaggerated response or adverse outcome later in life. One author, however, concludes that the degree to which these experiences are detrimental is unknown. I side with the latter opinion and advocate rigorously planned, randomized, controlled trials that include the evaluation of long-term neurodevelopmental outcomes as part of their design. Although we are now aware that fetuses and preterm and term infants have the anatomical, physiologic, and biochemical systems necessary to respond to painful stimuli, our ability to measure acute and chronic pain and to provide adequate pain relief in this population remains limited.

I strongly recommend this book to researchers and physicians in the fields of perinatal, neonatal, pediatric, and adolescent medicine. This recommendation is based not only on the specific facts provided on the different approaches to pain relief, but also on the authors' constructive attitude toward pain management in these age groups. It is our obligation to listen to and involve patients who have undergone neonatal intensive care or pediatric care and their families in an attempt to improve outcomes and satisfaction with care and to set the agenda for future research.

Arne Ohlsson, M.D.
University of Toronto, Toronto, ON M5G 1X5, Canada
aohlsson@mtsinai.on.ca