Pain Management in Pediatric Palliative Care
Stefan J. Friedrichsdorf, MD, Medical Director, Pain and Palliative Care Program, Children's Hospitals and Clinics of Minnesota
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The majority of the more than 14,000 children dying from life-limiting diseases in the USA each year suffer from pain during their last weeks of life. Data suggest that applying the World Health Organization principles of pain management results in good pain relief for the majority of children with advanced cancer; however less has been reported on the effectiveness of the WHO approach for non-malignant pediatric life-limiting conditions. The management of children with intractable pain remains challenging and requires an interdisciplinary approach. State of the art pain management in the 21st century requires that pharmacological management must be combined with integrative, non-pharmacological therapies to manage a child's pain and suffering effectively.
Only a few generations ago it was common in many families that infants and children died during their first years of life. Nowadays the death of a child is a rare and catastrophic incidence in industrialized countries and modern societies are often not prepared to deal with it. Palliative care for children and young people with life-limiting conditions is an active and total approach to care, embracing physical, emotional, social, and spiritual elements. It focuses on enhancement of quality of life for the child and support for the family, and includes management of distressing symptoms, provision of respite, and care through disease, death, and bereavement.  Among the many domains of pediatric palliative care, the management of distressing symptoms, especially pain, is one of the most important – but can only be seen in the global picture of a holistic, multidisciplinary approach to the child, siblings, and parents, and cannot be limited to the application of drugs during the last days of life.
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The Author: Stefan J. Friedrichsdorf, MD, is Diplomate of the American Board of Hospice and Palliative Medicine and the medical director of the Pain and Palliative Care Program at the Children's Hospitals and Clinics of Minnesota (CHCM), based in Minneapolis www.childrensmn.org. Dr. Friedrichsdorf, graduated from medical school in Lübeck, Germany and undertook Pediatric Training at the Vest Children's Hospital in Datteln, Germany; he had additional Palliative care training in Poland and the UK and in Hypnotherapy for Children by the Society for Developmental and Behavioral Pediatrics. He completed a Fellowship in Pediatric Pain & Palliative Care at the Children's Hospital at Westmead in Sydney, Australia. Dr. Friedrichsdorf leads the Children's interdisciplinary pain clinic, at CHCM and has published and lectured nationally and internationally on pediatric pain and palliative care.
Further information on ChiPPS, the Children’s Project on Palliative/Hospice Services, may be found at www.nhpco.org/i4a/pages/index.cfm?pageid=3409
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