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  • The Pain Treatment Service at Boston Children's Hospital was established in 1986 as the first multidisciplinary program in the world for acute and chronic pain management for children. Our program remains the most clinically active program of its kind in the world.

    We provide care for more than 2,000 patients each year, including children with:

    Patient-controlled analgesia is administered to about half of these patients and epidural anesthesia to another quarter. The remainder receive a variety of treatments, depending on their individual factors.

  • Pain medications, or analgesics, have a crucial role for many types of pain, including pain that occurs:

    • with surgery
    • immediately after major injuries
    • in patients with sickle cell disease having acute episodes
    • in patients with cancer

    For patients with short-term pain after surgery or major injuries, or for patients with cancer or sickle cell disease, it is widely agreed that opioid (narcotic) medications such as morphine, hydromorphone, oxycodone and methadone are very useful, and should be prescribed in most cases with an aim to reduce pain intensity to tolerable levels. These patients also commonly receive nonsteroidal anti-inflammatory drugs or NSAIDs. Ibuprofen (Motrin, Advil) and naproxen (Aleve) are examples of NSAIDs.

    What type of pain management is used for patients with chronic neuropathic pain?

    For patients with chronic neuropathic pain, the roles of opioid pain medications and NSAIDs are much less clear. Most patients with neuropathic pain do not get much relief from NSAIDs. While some adult patients with neuropathic pain get some pain relief from opioids, many others do not, and many of the patients who get some pain relief with opioids do so only at doses that are high enough to make them sleepy, dizzy, nauseated or unable to participate in normal activities. While oral medications may be continued during the program for some patients with neuropathic pain, the overall emphasis of the Pediatric Pain Rehabilitation Center at Children’s is on rehabilitative interventions for these patients, not on analgesic medications.

    How does Children’s approach pain management for burn injuries?

    Burns are among the most painful and devastating injuries. Severe burns can require long periods of treatment, including rehabilitation, skin grafts and physical therapy. A third-degree burn extends into the deeper tissues, causing white or charred skin that may be numb.

    Children who have experienced third-degree burns will experience pain (how much depends on the severity and location of the burn), which can make their stay in the hospital very traumatic. Your child will be given pain medication--through an intravenous line or by mouth--before the wound is taken care of.

    How do you treat the itching associated with burns?

    Most children who have suffered from a burn injury usually experience itching at some point during the healing process. Sometimes it begins right away—but it may also occur several weeks or months into the healing process. Itching can range from a minor irritation to severe discomfort that can interfere with daily activities. While there is no “cure” for itching, the condition diminishes over time.

    To soothe itchy skin, we suggest:

    • Keep the area moist with creams. Try to avoid lotions, as they may contain alcohol, which can dry the skin.

    • Avoid creams that contain perfumes, which may cause more irritation to the area.

    • Topical corticosteroids (such as hydrocortisone) may be recommended by your child’s physician.

    • Hemorrhoidal creams contain local anesthetics that are safe to use on the skin.

    • Cool or cold compresses may help provide relief.

    There are other medications that your child’s physician may prescribe, such as antihistamines and/or oral steroids.

  • Your child will be evaluated for the extent of his or her pain or discomfort. Specific treatment will be determined by your child’s physician based on the following:

    • your child’s age, overall health, and medical history

    • extent of the pain

    • your child’s tolerance for specific medications, procedures, or therapies

    • expectations for the course of the healing

    • your opinion or preference

  • An anesthesiologist carefully reviews your child’s situation before deciding on a pain management plan.  We are available 24 hours a day to adjust or modify the plan, and at all times, a team of anesthesiologists and nurses work together to manage each patient’s pain. If your child is in severe pain, he or she will be given medication through an intravenous (IV) line or by mouth before the wound is taken care of. If old enough, your child can help control the pain by rating it with a scoring tool. This helps the healthcare team know when and how much pain medication to give so that your child can be more comfortable.

    Could a child become addicted to pain medication?

    This is very rare because children are given such small amounts of pain medication for short time periods.

    How can a parent help ease the child’s discomfort?

    The nurse and child life therapist at Boston Children’s can help you find ways to comfort and distract your child to decrease her or her anxiety. We also recognize that pain affects the quality of both the patient and the family’s daily life. Learning techniques to actively manage the pain helps the effectiveness of pain treatment. Therefore, we often refer patients and their families to a clinical psychologist who specializes in the treatment of chronic pain.

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO