By Neil L. Schechter MD, Charles B. Berde MD PhD, Myron Yaster MD
This version contains new and multiplied info on NSAIDs, opioids, and local anesthesia. New chapters conceal sedation, soreness within the ICU, multidisciplinary discomfort prone, palliative care, and the long term results of discomfort. straightforward new gains comprise many extra illustrations of techniques.
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Extra info for Pain in Infants, Children, and Adolescents
Lidocaine-prilocaine cream (EMLA) and amethocaine gel are clearly effective local anesthetics from 29 to 42 weeks after gestation (68 ), and repeated application reduces the hypersensitivity that follows repeated heel-lance injury in the neonatal period (128 ). However, it does not block the direct response to heel lance itself or to a number of other painful procedures (67 ,69 ). This may be a reflection of the nature of the particular injury and the depth of nerve terminals involved in a heel lance compared with a very brief noxious stimulus such as venipuncture.
Neuropathic pain, not rare among children, is discussed in detail in Chapter 34 . A relatively small subgroup of patients experience persistent pain as a manifestation of psychiatric disease, what was formerly known as psychogenic pain or hypochondriasis and now is known as somatoform pain disorder. As discussed in Chapter 15 and Chapter 16 , this is relatively uncommon; a diagnosis of somatoform pain disorder should not be invoked simply as a diagnosis of exclusion but rather based on positive psychiatric findings.
One demonstration of this is that the mechanical sensory reflex threshold of preterm infants in an area of local tissue damage created by repeated heel lances is half the value of that on the intact contralateral heel (127 ). 31 application of lidocaine-prilocaine cream (128 ). This response can spread outside the immediate area of injury. Preterm infants with established unilateral leg injuries from repeated procedures in intensive care show significantly lower sensory thresholds even on the unaffected, contralateral foot (7 ).