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“Although the world is full of suffering, it is also full of the overcoming of it.” 

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Helen Keller, 1880–1968.

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The word patient derives from the Latin word patiens, or “one who suffers.” The concept that pain is a necessary part of illness or injury is ingrained in human thought. Until the advent of anesthesia in the 1800s, few means of pain relief were available. As cultural, religious, political, and medical ideas have evolved, attitudes concerning pain relief have progressed as well. The modern view, most recently expressed in a landmark article by Brennan, Carr, and Cousins, is that “the unreasonable failure to treat pain is poor medicine, unethical practice, and is an abrogation of a fundamental human right.”1

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Even as many advances in managing pain suffered by adults have been embraced, pain management for children has lagged behind. Early arguments suggesting that neonates have a reduced ability to experience pain or that pain is somehow enlightening and necessary for the maturing child have only slowly lost favor. To the child in pain, the rationalizations to deny treatment are of little comfort. Even the youngest neonates have shown a negative response to painful stimuli with signs of distress or withdrawal.2 Because of the plasticity of the central nervous system in the developing neonate, repeated pain may lead to abnormal reorganization and sensitization; however, analgesic intervention will reduce enhanced pain behavior in the infant, suggesting that analgesia can inhibit these changes.3,4

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Almost 30 years ago, the first published reports of the undertreatment of pain in children appeared. Although numerous studies followed and education in pediatric pain management has been greatly expanded, the inadequate treatment of pain in children remains a problem throughout the world’s health care systems. 

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Every medical provider should aspire to provide appropriate pain management to the pediatric patient using all available options for treatment or prevention. An individualized pain management plan should be established with the goal of returning the child to normal activities such as moving, playing, bathing, and interacting with his or her surroundings. If appropriate, family and caregivers should be involved in formulating the plan. They should be educated about aspects of the plan and encouraged to be a part of the overall pain treatment strategy. The medical provider should perform an initial assessment, frequent reassessments, and an evaluation of the success of pain interventions. Relief of procedural pain (eg, from needle sticks) should be of consistent concern. Preoperative interventions such as epidural analgesia or regional anesthesia should be an integral part of the overall management of painful surgery. Ultimately, pediatric patients should be provided with a safe, comforting environment that minimizes the destructive effects of illness or injury.

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The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described ...

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