RESUMO
INTRODUCTION: At a single-center pediatric hospital, the neurokinin-1 receptor antagonist aprepitant was used to treat refractory pruritus in epidermolysis bullosa (EB) and atopic dermatitis (AD). METHODS: Thirty-seven patients were included (24 EB patients, 13 AD patients), ages 10 months to 37 years. RESULTS: 58% (14/24) of patients with EB and 85% (11/13) of patients with AD reported aprepitant was effective in decreasing their pruritus, with age-related differences in efficacy observed in EB patients, and access to the medication by insurance denial or availability of the drug as a barrier to use. CONCLUSIONS: Aprepitant shows promise in controlling refractory pruritus in pediatric EB and AD patients and deserves further study.
Assuntos
Aprepitanto , Dermatite Atópica , Epidermólise Bolhosa , Prurido , Humanos , Aprepitanto/uso terapêutico , Prurido/tratamento farmacológico , Prurido/etiologia , Criança , Estudos Retrospectivos , Masculino , Feminino , Adolescente , Pré-Escolar , Lactente , Dermatite Atópica/complicações , Dermatite Atópica/tratamento farmacológico , Adulto , Adulto Jovem , Epidermólise Bolhosa/complicações , Epidermólise Bolhosa/tratamento farmacológico , Resultado do Tratamento , Antagonistas dos Receptores de Neurocinina-1/uso terapêuticoAssuntos
Anemia Falciforme/complicações , Dor/complicações , Dor/reabilitação , Adolescente , Analgésicos/uso terapêutico , Anemia Falciforme/terapia , Antidrepanocíticos/uso terapêutico , Transfusão de Sangue , Dor Crônica/complicações , Dor Crônica/reabilitação , Feminino , Humanos , Hidroxiureia/uso terapêutico , MasculinoRESUMO
Chronic pain in children is a relatively prevalent cause of functional disability. Contributing factors to this pain are best viewed through the biopsychosocial model. Although evidence is lacking for individual aspects of treatment, interdisciplinary care is considered the best treatment approach for children with chronic pain. Interdisciplinary care can include medication management with daily and as-needed medications, physical and occupational therapy focusing on function and movement, and psychological treatment with cognitive-behavioral therapy and acceptance focused treatment. In children with severe pain and disability, intensive interdisciplinary pain treatment may be needed to improve pain and function.
Assuntos
Dor Crônica , Terapia Cognitivo-Comportamental , Humanos , Criança , Dor Crônica/etiologia , Dor Crônica/terapia , Dor Crônica/psicologia , Manejo da DorRESUMO
OBJECTIVES: Evidence for the effectiveness of intensive interdisciplinary pain treatment (IIPT) for pediatric chronic pain is growing; however, little research has considered factors that contribute to differences in patients' treatment response. The present study utilized multilevel modeling to examine trajectory of change over time in functional disability from clinic assessment to 6-month follow-up in pediatric patients participating in IIPT, considering spatial distribution of pain, coping efficacy, and pain intensity. MATERIALS AND METHODS: Participants included 110 pediatric patients (Mage=14.65, SD=2.37; localized pain, 27.3%; widespread pain, 72.7%) consecutively admitted into IIPT. Patients completed self-report measures of functional disability, pain intensity, and coping efficacy at pretreatment assessment, admission, weekly during IIPT, discharge, and several follow-ups. RESULTS: Analysis identified a model with 3 three-way interactions, including time, time squared, pain intensity, coping efficacy, and pain distribution, on functional disability. The spatial distribution of pain had the greatest impact on treatment trajectory in patients with widespread pain, high pain intensity, and poor coping efficacy; these patients demonstrated greater functional disability compared with patients with localized pain. In addition, patients with widespread pain and poor coping efficacy had the most functional disability across all levels of pain intensity. Patients with localized pain and poor coping efficacy demonstrated initial treatment gains, but evidenced an increase in functional disability at follow-up. DISCUSSION: Overall, spatial distribution of pain, coping efficacy, and pain intensity played an important role in patients' response to treatment. Better understanding of these variables could improve treatment response, particularly for the most severely disabled chronic pain patients.
Assuntos
Adaptação Psicológica , Dor Crônica , Pessoas com Deficiência , Manejo da Dor , Criança , Dor Crônica/terapia , Humanos , Medição da DorRESUMO
The COVID-19 pandemic has been a challenge to healthcare systems around the world. Within pediatric rehabilitation medicine, management of intrathecal baclofen has been particularly challenging. This editorial reviews how programs in the US and Canada coped with the quickly changing healthcare environment and how we can learn from this pandemic to be prepared for future crises.