Routine use of the Bath Adolescent Pain Questionnaire in a paediatric pain clinic.

INTRODUCTION: Assessment of outcomes from health interventions are of increasing importance, primarily to identify effective and safe treatment, but also to justify funding decisions. The Bath Adolescent Pain Questionnaire (BAPQ) is a self-report questionnaire, validated in 11-18 year olds, assessing the impact of pain in multiple domains of adolescent life. The similarly validated Bath Adolescent Pain Questionnaire for Parents (BAPQ-P) uses the same domains as the BAPQ, assessing the functioning and development of the adolescent from the parents' perspective. METHODS: We conducted a prospective study, planning to routinely collect BAPQ/BAPQ-P data at initial assessment and 6 months later. All patients aged between 5 and 19 attending our chronic pain clinic for the first time between December 2009 and December 2014 were mailed BAPQ and BAPQ-P questionnaires before the first appointment and 6 months after the first appointment. RESULTS: In total, 376 of 386 families returned questionnaires at time 0 and 96 after 6 months, 26% of those responded at time 0. We found statistically significant differences on patients' BAPQ questionnaires from 0 to 6 months showing improvement in all domains. A different result was found on parents' questionnaires where we only found a statistically significant difference on daily and emotional functioning. When comparing patient and parent questionnaires at 0 and 6 months, we found statistically significant differences between patients' and parents' questionnaires in the daily functioning and development domains. CONCLUSION: We believe BAPQ and BAPQ-P measurement proved useful tools to assess response to pain management input in adolescents over a 6-month period. Our experience and results suggest that these tools can, with appropriate administrative support, be used in routine clinical practice to assess patient outcomes. We also believe that BAPQ and BAPQ-P measurements have a utility to audit pain clinic activity and potentially a use in demonstrating beneficial outcomes to commissioners.

Lidocaine 5%-medicated plaster (Versatis) for localised neuropathic pain: results of a multicentre evaluation of use in children and adolescents.

The Lidocaine 5% plaster is licensed for the symptomatic relief of neuropathic pain associated with post-herpetic neuralgia in adult patients over 18 years of age. Studies in adults also demonstrate efficacy of Lidocaine 5% plasters in other neuropathic pain conditions. Case reports and experience suggested efficacy of Lidocaine 5% plasters in children and adolescents with localised neuropathic pain. Initiated by the Pain in Children Special Interest Group (PICSIG) of the British Pain Society, a 3-year prospective multicentre service evaluation was undertaken to document the usage and efficacy of the Lidocaine 5% plaster in paediatric patients being managed by paediatric pain teams in the United Kingdom. Five paediatric pain teams provided anonymised data pre-treatment and 3-6 months after commencing Lidocaine 5% plaster. Changes in pain score, function, sleep and continuing use were evaluated. Data were obtained for 115 patients; age range 5-18 years (mean: 12 years). Diagnosis and site of application varied. Benefit from use of a Lidocaine 5% plaster in an individual was deemed if two or more of the following were reported: reduction in pain score, functional improvement, sleep improvement and continuing use of Lidocaine 5% plaster. Benefit was recorded for 79 patients (69%); 32 patients were recorded as receiving no benefit and data were unavailable for 4 patients, and 7 patients reported minor skin reactions. This prospective service evaluation supports the efficacy of the Lidocaine 5% plaster in children and adolescents with localised neuropathic pain and confirms tolerability and safety. It is the opinion of the PICSIG of the British Pain Society that the Lidocaine 5% plaster should be considered early in the multidisciplinary management of localised neuropathic pain in children and adolescents.

Chronic pain in children and young people.

PURPOSE OF REVIEW: In response to a considerable volume of clinical research into chronic pain in children and young people, recent systematic reviews now provide an evidence base for management. Clinicians should be aware of this evidence and areas in which evidence is lacking. RECENT FINDINGS: There is a strong evidence base for psychological interventions in several conditions; computerized delivery with therapist support shows promise. Multidisciplinary services are required for a small cohort of patients. The role and effects of parents in their child's pain is becoming clearer; effective interventions for parents are being developed. The evidence for effective pharmacotherapy is poor, apart from the acute management of headache. SUMMARY: Clinicians need to be aware of the therapeutic effect of the psychosocial approach to the management of chronic pain in children and young people. Further research is required into the pharmacological and physical aspects of management, which remain important.

Movement disorders associated with complex regional pain syndrome in children.

The aim of the present study was to review the history, clinical course, treatment, and outcome of movement disorders in children and young people with complex regional pain syndrome (CRPS). Case notes were reviewed retrospectively of children and young people who presented with movement disorders in CRPS to our tertiary paediatric pain service over a period of 13 years. Ten children with CRPS presented with movement disorders (eight females, two males). The age at first presentation with symptoms of CRPS ranged from 8 to 15 years (mean 11 y 2 mo, median 13 y). The most common movement disorder was dystonia (n=8), followed by tremors (n=3) and myoclonus (n=3); two patients had all three movement disorders. The movement disorder affected mainly the lower limb (n=9) with a predilection for the foot (n=7) and was frequently initiated by minor trauma (n=7). Follow-up ranged from 6 months to 14 years. The outcome was variable, with good prognosis in nearly half of the cases: four children experienced complete resolution of symptoms. Two children showed a slight improvement. Four children showed no improvement. Movement disorders in CRPS are under-recognized in children. The management has to be multidisciplinary with an expertise in paediatric pain.