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Neuropediatrics 2013; 44(03): 142-146
DOI: 10.1055/s-0032-1332740
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Does Anticonvulsant Treatment Influence Pain Perception in Epileptic Children?

Pietro Ferrara
1   Department of Pediatric Sciences, “A. Gemelli” University Hospital, Rome, Italy
2   Division of Pediatric Ambulatory, Campus Bio-Medico University, Rome, Italy
,
Giorgia Bottaro
2   Division of Pediatric Ambulatory, Campus Bio-Medico University, Rome, Italy
,
Silvia Angeletti
3   Clinical Pathology, Campus Bio-Medico University, Rome, Italy
,
Francesca Ianniello
1   Department of Pediatric Sciences, “A. Gemelli” University Hospital, Rome, Italy
,
Valerio Romano
1   Department of Pediatric Sciences, “A. Gemelli” University Hospital, Rome, Italy
,
Francesca del Bufalo
2   Division of Pediatric Ambulatory, Campus Bio-Medico University, Rome, Italy
,
Antonio Chiaretti
1   Department of Pediatric Sciences, “A. Gemelli” University Hospital, Rome, Italy
,
Domenica Battaglia
4   Department of Child Neurology, “A. Gemelli” University Hospital, Rome, Italy
,
Giordano Dicuonzo
3   Clinical Pathology, Campus Bio-Medico University, Rome, Italy
› Author Affiliations
Further Information

Publication History

19 June 2012

23 October 2012

Publication Date:
20 February 2013 (online)

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Abstract

Background The aims of our study were to evaluate pain perception in epileptic children and to establish the influence of anticonvulsant drugs on pain perception.

Methods The study involved 40 children, 30 with epilepsy and 10 healthy control subjects. In the group of epileptic children, 10 were not treated and 20 assumed a single drug. From all children of each group, one sample of saliva was collected through a noninvasive device 15 minutes before (t0), during (t1), and 15 minutes after (t2) blood withdrawal, and salivary α-amylase activity was then determined.

Results No statistically significant difference was found at t0 and at t1, indicating that in both groups venipuncture equally induced a state of stress. Conversely, at t2 a statistically significant difference (p = 0.0195) was found, suggesting that epileptic children presented a greater sensitization to pain and a slower recovery from stress. Comparing furthermore data obtained in children with epilepsy not treated with those registered in treated ones, we found a statistically significant difference at t0 (p = 0.012), at t1 (p = 0.037), and at t2 (p = 0.011).

Conclusions Anticonvulsant drugs do not seem to influence pain perception and enzymatic activity levels in epileptic patients.

Keywords

anticonvulsant - pain - children - epileptic - amylase
 

  • References

  • 1 Mathews L. Pain in children: neglected, unaddressed and mismanaged. Indian J Palliat Care 2011; 17 (Suppl): S70-S73
    PubMedGoogle Scholar
  • 2 Howard RF. Current status of pain management in children. JAMA 2003; 290 (18) 2464-2469
    CrossrefPubMedGoogle Scholar
  • 3 Ashley EMC. Managing perioperative pain in special circumstances: paediatric pain management. In: Cox F, , ed. Perioperative Pain Management. Oxford, UK: Wiley-Blackwell; 2009: 203-216
    Google Scholar
  • 4 Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine (ANZCA). Macintyre PE, Scott DA, Schug SA, Visser EJ, Walker SM , eds. Acute Pain Management: Scientific Evidence. Third Edition. Melbourne, Australia. Approved by the NHMRC on 4 February 2010. ISBN Print: 978-0-977517-4-4-2
    Google Scholar
  • 5 Schuller C, Känel N, Müller O , et al. Stress and pain response of neonates after spontaneous birth and vacuum-assisted and cesarean delivery. Am J Obstet Gynecol 2012; 207 (5) 416.e1–e6
    PubMedGoogle Scholar
  • 6 Mantagos S, Koulouris A, Vagenakis A. A simple stress test for the evaluation of hypothalamic-pituitary-adrenal axis during the first 6 months of life. J Clin Endocrinol Metab 1991; 72 (1) 214-216
    CrossrefPubMedGoogle Scholar
  • 7 Lindh V, Wiklund U, Håkansson S. Heel lancing in term new-born infants: an evaluation of pain by frequency domain analysis of heart rate variability. Pain 1999; 80 (1–2) 143-148
    CrossrefPubMedGoogle Scholar
  • 8 Lewis M, Ramsay D. Stability and change in cortisol and behavioral response to stress during the first 18 months of life. Dev Psychobiol 1995; 28 (8) 419-428
    CrossrefPubMedGoogle Scholar
  • 9 Hunt A, Mastroyannopoulou K, Goldman A, Seers K. Not knowing—the problem of pain in children with severe neurological impairment. Int J Nurs Stud 2003; 40 (2) 171-183
    CrossrefPubMedGoogle Scholar
  • 10 McJunkins A, Green A, Anand KJ. Pain assessment in cognitively impaired, functionally impaired children: pilot study results. J Pediatr Nurs 2010; 25 (4) 307-309
    PubMedGoogle Scholar
  • 11 International Association for the Study of Pain. Why children's pain matters. PAIN Clinical Updates 2005; (XIII,4) 1-6
    PubMedGoogle Scholar
  • 12 Hallström I, Elander G. Decision-making during hospitalization: parents' and children's involvement. J Clin Nurs 2004; 13 (3) 367-375
    CrossrefPubMedGoogle Scholar
  • 13 Azize PM, Humphreys A, Cattani A. The impact of language on the expression and assessment of pain in children. Intensive Crit Care Nurs 2011; 27 (5) 235-243
    CrossrefPubMedGoogle Scholar
  • 14 Stallard P, Williams L, Lenton S, Velleman R. Pain in cognitively impaired, non-communicating children. Arch Dis Child 2001; 85 (6) 460-462
    CrossrefPubMedGoogle Scholar
  • 15 Breau LM, Camfield CS, McGrath PJ, Finley GA. The incidence of pain in children with severe cognitive impairments. Arch Pediatr Adolesc Med 2003; 157 (12) 1219-1226
    CrossrefPubMedGoogle Scholar
  • 16 Hunt A, Goldman A, Seers K , et al. Clinical validation of the paediatric pain profile. Dev Med Child Neurol 2004; 46 (1) 9-18
    PubMedGoogle Scholar
  • 17 Schechter NL. The undertreatment of pain in children: an overview. Pediatr Clin North Am 1989; 36 (4) 781-794
    PubMedGoogle Scholar
  • 18 McGrath PJ, Frager G. Psychological barriers to optimal pain management in infants and children. Clin J Pain 1996; 12 (2) 135-141
    CrossrefPubMedGoogle Scholar
  • 19 Craig KD, Badali MA. Introduction to the special series on pain deception and malingering. Clin J Pain 2004; 20 (6) 377-382
    CrossrefPubMedGoogle Scholar
  • 20 Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs 1988; 14 (1) 9-17
    PubMedGoogle Scholar
  • 21 Beyer JE, Aradine CR. Patterns of pediatric pain intensity: a methodological investigation of a self-report scale. Clin J Pain 1987; 3: 130-141
    CrossrefPubMedGoogle Scholar
  • 22 Abu-Saad HH, Hamers JPH. Decision-making and paediatric pain: a review. J Adv Nurs 1997; 26 (5) 946-952
    CrossrefPubMedGoogle Scholar
  • 23 Howard R, Carter B, Curry J , et al; Association of Paediatric Anaesthetists of Great Britain and Ireland. Good practice in postoperative and procedural pain management. Background. Paediatr Anaesth 2008; 18 (Suppl. 01) 1-3
    CrossrefPubMedGoogle Scholar
  • 24 Breau LM, McGrath PJ, Camfield CS, Finley GA. Psychometric properties of the non-communicating children's pain checklist-revised. Pain 2002; 99 (1–2) 349-357
    CrossrefPubMedGoogle Scholar
  • 25 Collignon P, Giusiano B. Validation of a pain evaluation scale for patients with severe cerebral palsy. Eur J Pain 2001; 5 (4) 433-442
    CrossrefPubMedGoogle Scholar
  • 26 Hunt A, Goldman A, Seers K , et al. Clinical validation of the paediatric pain profile. Dev Med Child Neurol 2004; 46 (1) 9-18
    PubMedGoogle Scholar
  • 27 Hunt A, Mastroyannopoulou K, Goldman A, Seers K. Not knowing—the problem of pain in children with severe neurological impairment. Int J Nurs Stud 2003; 40 (2) 171-183
    CrossrefPubMedGoogle Scholar
  • 28 Stallard P, Williams L, Velleman R, Lenton S, McGrath PJ, Taylor G. The development and evaluation of the pain indicator for communicatively impaired children (PICIC). Pain 2002; 98 (1–2) 145-149
    CrossrefPubMedGoogle Scholar
  • 29 Worley A, Fabrizi L, Boyd S, Slater R. Multi-modal pain measurements in infants. J Neurosci Methods 2012; Apr 15; 205 (2) 252-257
    CrossrefPubMedGoogle Scholar
  • 30 Hamamoto K, Ogawa A, Mitsudome A. Effect of aging on autonomic function in individuals with severe motor and intellectual disabilities. Brain Dev 2003; 25 (5) 326-329
    CrossrefPubMedGoogle Scholar
  • 31 Block AR. Investigation of the response of the spouse to chronic pain behavior. Psychosom Med 1981; 43 (5) 415-422
    PubMedGoogle Scholar
  • 32 Gilman SC, Fischer GJ, Biersner RJ, Thornton RD, Miller DA. Human parotid alpha-amylase secretion as a function of chronic hyperbaric exposure. Undersea Biomed Res 1979; 6: 303-307
    PubMedGoogle Scholar
  • 33 Chatterton Jr RT, Vogelsong KM, Lu YC, Ellman AB, Hudgens GA. Salivary alpha-amylase as a measure of endogenous adrenergic activity. Clin Physiol 1996; 16 (4) 433-448
    CrossrefPubMedGoogle Scholar
  • 34 Granger DA, Kivlighan KT, el-Sheikh M, Gordis EB, Stroud LR. Salivary alpha-amylase in biobehavioral research: recent developments and applications. Ann N Y Acad Sci 2007; 1098: 122-144
    CrossrefPubMedGoogle Scholar
  • 35 Rohleder N, Nater UM, Wolf JM, Ehlert U, Kirschbaum C. Psychosocial stress-induced activation of salivary alpha-amylase: an indicator of sympathetic activity?. Ann N Y Acad Sci 2004; 1032: 258-263
    CrossrefPubMedGoogle Scholar
  • 36 Asking B, Gjörstrup P. Synthesis and secretion of amylase in the rat parotid gland following autonomic nerve stimulation in vivo. Acta Physiol Scand 1987; 130 (3) 439-445
    CrossrefPubMedGoogle Scholar
  • 37 Schneyer CA, Hall HD. Effects of varying frequency of sympathetic stimulation on chloride and amylase levels of saliva elicited from rat parotid gland with electrical stimulation of both autonomic nerves. Proc Soc Exp Biol Med 1991; 196 (3) 333-337
    PubMedGoogle Scholar
  • 38 Nater UM, La Marca R, Florin L , et al. Stress-induced changes in human salivary alpha-amylase activity — associations with adrenergic activity. Psychoneuroendocrinology 2006; 31 (1) 49-58
    CrossrefPubMedGoogle Scholar