CLINICAL CARE FRAMEWORK
Chronic Pain in Children with Severe Impairment of the Central Nervous System: A Framework for Assessment and Initial Management
JULIE M HAUER MD
Children with severe impairment of the central nervous system (CNS), often referred to as children with severe neurological impairment (SNI), have a significantly higher incidence of acute and chronic pain compared to children with mild impairment or with typical development. This article is focused on chronic pain sources due to the altered CNS, referred to as neuro-pain in this article. Chronic pain has a significant impact on quality of life and health outcomes of the child and family. It requires a distinctly different approach from acute pain, including goals of treatment. A case example highlights many of the challenges that delay treatment for neuro-pain, including lack of diagnostic tests or criteria, risk for multiple comorbid problems, and the impact of cognitive bias. A proposed screening process and assessment tool are provided, intended to identify children at risk for neuro-pain as a reason for recurrent symptoms who therefore may benefit from a medication trial for neuro-pain. Parents also face many worries throughout this process. Language strategies are provided to assist with needed support.