Understanding Arthritis
Treatment of Pain in Children and Older Adults with Arthritis
These recommendations are presented in abbreviated form. Readers should refer to the text of the guideline document1 for a detailed discussion of each of the following topics.
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The assessment of pain should be ongoing in any child with Juvenile chronic arthritis (JCA). A comprehensive and developmentally appropriate pain assessment should incorporate a pain history, the child’s self report, behavioral observations, parents’ assessment, and physiologic cues.
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Analgesia for children should be similar to that for adults who experience pain.
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Patient/family education should be provided on an ongoing basis to increase self-care skills and feelings of self-efficacy and to develop self-advocacy skills for negotiating with the healthcare system.
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Cognitive-behavioral therapy (CBT) should be used to reduce pain and psychological disability and to enhance self-efficacy and pain coping for children.
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Appropriate interventions to minimize pain and anxiety related to diagnostic and therapeutic procedures should be an integral part of the management of children with arthritis. The child and parent should be adequately prepared for any procedure, and interventions should be individualized for the child and the procedure and administered prophylactically.
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Whenever conscious or deep sedation is required to perform any procedure, the guidelines developed by the American Academy of Pediatrics for patient monitoring and resuscitative equipment should be followed.
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The antiinflammatory and analgesic benefits of nonsteroidal antiinflammatory drugs (NSAIDs) should be weighed against the potential risk, particularly in older people. In the person who is at increased risk for a serious upper gastrointestinal (GI) adverse event, gastroprotective agents should be used even if nonselective agents are given at low doses.
References:
1. Available at: http://www.guidelines.gov/ and originally adapted from: Simon LS, Lipman AG, Jacox AK et al Pain in osteoarthritis, rheumatoid arthritis, and juvenile chronic arthritis.2nd ed. Glenview (IL): American Pain Society (APS); 2002. 179 p. (Clinical practice guideline; no. 2).