COMPLEX ASSESSMENT AND PAIN CONTROL IN PEDIATRIC NON-ONCOLOGICAL PALLIATIVE CARE USING PHYSICAL THERAPY

Abstract

Abstract. Pediatric non-oncology care is represented by multi-vector tasks. One of them is detection, evaluation, control and therapy of chronic pain syndrome. In pediatric non-oncology care, pain assessment is an important component of patient management, but this problem remains understudied and underdeveloped. The purpose of the study is to analyze the effectiveness of physical therapy in the process of pain relief in children who need non-oncological palliative care. To study the problem, research methods were selected that would reflect: analysis and generalization of data from scientific and methodological and special literature, documentary materials, collection of anamnesis, objective examination. To assess the intensity of pain, the following were used: Children's scale for pain assessment by facial expressions of Wong-Baker (1988), Assessment of pain in children who do not know how to speak or with impaired speech function (from 6 months to 7 years) – FLACC scale, visual- analog scale (VAS), Children's pain assessment scale KUSS (1998). The study was conducted on the basis of the educational and rehabilitation center «Special Child». Research results. Analysis of pain assessment in children proved that all patients suffer from chronic pain of varying intensity. During the evaluation, the factors that were taken into account during the assessment of pain were systematized: time of day of pain onset, duration, localization, frequency, provoking factors; the child's ability to independently report pain; detection of uncharacteristic behavior of a non-verbal child, which testifies to the experience of pain. Patients in the comparison group received pain therapy, which is specified in the Unified Clinical Protocol of Palliative Medical Care for Chronic Pain Syndrome. Patients of the main group received therapeutic services represented by positioning, orthosis, massage, dance and movement therapy, performing therapeutic exercises to musical accompaniment, with gymnastic objects. The criterion for the effectiveness of pain therapy was an increase in periods of remission of pain symptoms, a decrease in the intensity of pain and the duration of discomfort. The current follow-up examination was performed dynamically after 6 months and after 12 months. Thus, in the patients of the main group, moderate pain decreased in 13 (54%) patients, severe pain – in 5 (21%) patients, excessive pain – in 3 (13%). In the comparison group, excessive pain passed in 1 (4%) children, severe pain decreased in 2 (9%) children, moderate pain in 2 (9%) children. Conclusions. The problem of pain assessment in the management of pediatric palliative patients is the subject of research by scientists and clinical workers. The choice of rating scales should be based on the presence of cognitive, speech, and communication abilities of patients. To control the intensity and taming of pain of non-ecological etiology, there are a number of interventions that a physical therapist can effectively apply, as they declare positive effects, in combination with protocol physiotherapy methods.