Restraint is used relatively often during pediatric care. However, no scale has yet been validated to assess its intensity. The study presented here did this for the Procedural Restraint Intensity in Children tool in metrological terms (with some limitations). In the absence of a reference scale in this area, the reliability of this tool was studied under experimental conditions. It is nevertheless the first scale with metrological validation, measuring the intensity of physical constraint. Other work is underway to validate it in real clinical situations.

Restraint is used relatively often during pediatric care. However, no scale has yet been validated to assess its intensity. The study presented here did this for the Procedural Restraint Intensity in Children tool in metrological terms (with some limitations). In the absence of a reference scale in this area, the reliability of this tool was studied under experimental conditions. It is nevertheless the first scale with metrological validation, measuring the intensity of physical constraint. Other work is underway to validate it in real clinical situations.

NOCEBO PLACEBO, THE HIDDEN SIDE OF OUR TREATMENTS. Our knowledge of the placebo effect and its opposite, the nocebo effect, has changed dramatically in the last 20 years. Any treatment activity induces this type of effect. The placebo groups in clinical studies have biases that profoundly alter their neutrality. The nocebo effect is omnipresent in daily practice, it contributes to induce many of the adverse drug effects. The use of «impure» placebos is also widespread in daily practice. The placebo effect has an objectivable and reproducible neurobiological substrate. Its therapeutic effects are well documented. Disorders, symptoms involving the central nervous system (CNS) respond more easily to placebo. These new data make it possible to improve clinical practices by developing the quality of relationships with patients and families as well as the methodology of clinical trials.

Le protoxyde d’azote (N2O) est un médicament : son utilisation doit faire l’objet d’une prescription.

Pediatric AnesthesiaVolume 30, Issue 4 p. 388-389 EDITORIAL Nitrous oxide (N2O) angel or devil? Daniel Annequin, Corresponding Author daniel.annequin@aphp.fr orcid.org/0000-0001-6425-4016 Centre de la Douleur, de la Migraine de L'enfant et de L'adolescent, Hôpital Trousseau Paris Assistance Publique Hôpitaux de Paris, AP-HP Sorbonne University, Paris, France Correspondence Pr Daniel Annequin, Centre de la Douleur, de la Migraine de L'enfant et de L'adolescent, Hôpital Trousseau, 75012 Paris, France. Email: daniel.annequin@aphp.frSearch for more papers by this author Daniel Annequin, Corresponding Author daniel.annequin@aphp.fr orcid.org/0000-0001-6425-4016 Centre de la Douleur, de la Migraine de L'enfant et de L'adolescent, Hôpital Trousseau Paris Assistance Publique Hôpitaux de Paris, AP-HP Sorbonne University, Paris, France Correspondence Pr Daniel Annequin, Centre de la Douleur, de la Migraine de L'enfant et de L'adolescent, Hôpital Trousseau, 75012 Paris, France. Email: daniel.annequin@aphp.frSearch for more papers by this author First published: 22 April 2020 https://doi.org/10.1111/pan.13834Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume30, Issue4April 2020Pages 388-389 RelatedInformation

Les médicaments de la douleur font l’objet de craintes souvent majeures. Le protoxyde d’azote associé à 50 % d’oxygène (MEOPA) est le produit de référence pour la douleur provoquée par les soins en pédiatrie. Le mésusage des cartouches de protoxyde d’azote pur à visée récréative peut avoir des effets indésirables majeurs lors d’expositions très prolongées ; il ne doit pas être confondu avec le MEOPA à usage médical dont le rapport bénéfice/risque est très rassurant. L’usage massif des opiacés essentiellement aux États-Unis pour des douleurs chroniques a donné lieu à une catastrophe sanitaire. Ces produits demeurent les produits de référence pour traiter les douleurs aiguës et intenses, et le risque de mésusage y est exceptionnel quand ils sont utilisés sur des durées courtes avec un suivi clinique. En revanche, un risque réel existe lors de l’utilisation prolongée de ces médicaments dans la douleur chronique non cancéreuse ; cette dernière nécessite une véritable prise en charge pluridisciplinaire permettant d’éviter au maximum les médicaments antalgiques. En France, la peur de l’utilisation des AINS est ancienne et en grande partie infondée. Elle s’est exprimée récemment par des avis officiels erronés recommandant d’éviter l’ibuprofène lors de la première vague de la SARS-CoV-2. Le paracétamol a au contraire en France une image de sécurité surévaluée auprès des médecins et du public. Nos connaissances sur les risques liés aux médicaments de la douleur se sont enrichies ces dernières années. Si la vigilance des professionnels doit être continue, elle ne doit pas se transformer en suspicion. Les bonnes pratiques doivent être mieux diffusées notamment sur la prise en charge de la douleur chronique. L’amplification par les médias et les réseaux sociaux qui ne soulignent que les effets indésirables, voire les décès, occultent tous les bénéfices majeurs apportés par ces produits qui restent dans la grande majorité des cas des produits de référence. À l’inverse, les conséquences dramatiques (sanitaires et humaines) peuvent encore s’observer massivement dans les pays pauvres qui n’ont quasiment aucun accès aux médicaments de la douleur.

Introduction Gabapentin is currently used ‘off-label’ in children and adolescents with chronic neuropathic pain, and reliable evidence of its effects and optimal dosing are lacking. Objectives The GABA-1 trial aims to compare the efficacy and safety of gabapentin liquid formulation relative to tramadol and to explore the pharmacokinetics of both drugs in the treatment of chronic, neuropathic or mixed pain in the paediatric population. Methods and analysis The trial is a multicentre, double-blind, double-dummy, randomised, active-controlled, non-inferiority trial. Participants aged from 3 months to <18 years of age with moderate to severe (≥4/10 in age-appropriate pain scales) chronic neuropathic or mixed pain will be recruited in 14 clinical sites in eight European countries. A total of 94 subjects will be randomised to receive gabapentin and tramadol placebo or tramadol and gabapentin placebo throughout 16–19 weeks (including 3 weeks of titration [optimisation period], 12 weeks of treatment at a stable dose [maintenance period] and 1–4 weeks of tapering [discontinuation period]). The primary objective is to assess the efficacy of gabapentin relative to tramadol for the treatment of moderate to severe chronic neuropathic or mixed pain by comparing the difference in average pain scores (assessed by age-appropriate pain scales) between intervention arms after 15 weeks of treatment. Secondary objectives include the assessment of the safety, quality of life and global satisfaction with treatment and the description of the pharmacokinetic–pharmacodynamic relationship of gabapentin liquid formulation and tramadol oral drops to validate the recommended paediatric doses. Only rescue pain medication by paracetamol and/or ibuprofen is allowed during the trial. Ethics and dissemination Ethic approval was obtained in the eight participating countries. Results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. Trial registration numbers 2014-004851-30 and NCT02722603. Trial status Ongoing research study, currently recruiting.

AimTo describe the clinico‐radiological phenotype of children with a CACNA1A mutation and to precisely evaluate their learning ability and cognitive status.MethodChildren between the ages of 3 and 18 years harboring a pathogenic CACNA1A mutation associated with episodic ataxia, hemiplegic migraine, benign paroxysmal torticollis, benign paroxysmal vertigo, or benign paroxysmal tonic upgaze, were enrolled in this cross‐sectional study. Data concerning psychomotor development, academic performance, educational management, clinical examination at inclusion, and brain imaging were collected. Cognitive assessment was performed using age‐standardized scales.ResultsEighteen patients (nine males, nine females; mean age at inclusion: 11y 7mo [SD 4y 5mo; range 3y–17y 11mo]) from 14 families were enrolled. Eleven patients displayed the coexistence or consecutive occurrence of more than one type of episodic event. Nine patients exhibited abnormal neurological examination at inclusion. Brain magnetic resonance imaging (MRI) showed cerebellar atrophy in five patients. Psychomotor development was delayed in nine patients and academic difficulties were reported by the parents in 15 patients; nine patients were in special education. Impairment of intellectual function was assessed in six of the 12 patients with interpretable Full‐scale IQ scores and was more frequent when cerebellar atrophy was present on MRI.InterpretationCognitive impairment is commonly associated with CACNA1A mutations. We suggest that CACNA1A‐associated phenotype should be considered a neurodevelopmental disorder.What this paper adds Cognitive disabilities and academic difficulties are common in children with CACNA1A mutations associated with episodic syndromes. Cognitive function ranges from normal to moderate intellectual disorder in wheelchair‐dependent children. Patients with vermian atrophy are at a higher risk of cognitive impairment.

Los actuales medios analgésicos permiten tratar la gran mayoría de los dolores del niño. La ansiedad aumenta la percepción del dolor, por lo que los métodos de distracción «desenfocan» la atención del niño y son muy útiles. A partir de la edad de 4-6 años, el niño puede evaluar el nivel de su dolor por sí mismo. Para los más pequeños, las escalas de observación conductual son necesarias. El dolor intenso requiere analgésicos de nivel 2 o 3 de forma inmediata, excepto para los episodios migrañosos, algunos dolores neuropáticos y el dolor psicógeno. La codeína ya no se receta en niños menores de 12 años. Se recomienda, de acuerdo con la Haute Autorité de Santé (HAS), administrar tramadol y sobre todo ibuprofeno, que tiene un margen de seguridad muy amplio. La eficacia de un fármaco se observa en 5-10 minutos por vía intravenosa, en 30 minutos por vía oral y en 15-30 minutos por vía rectal. Se debe entregar una prescripción alternativa para usar en caso de ineficacia de la primera. En niños menores de 4 meses, 2 minutos antes de una efracción cutánea son eficaces la ingesta oral de glucosa al 30%, la succión del chupete y la lactancia materna. La inhalación de mezcla equimolar de oxígeno y óxido de nitrógeno (MEOPA) y la aplicación de crema anestésica son formas simples de controlar de manera eficaz y sencilla muchos dolores causados por procedimientos (en particular en servicios de urgencias). La migraña afecta al 5-10% de los niños y es la principal causa de cefalea primaria recurrente en niños. El ibuprofeno (10 mg/kg) es el tratamiento de referencia para el episodio. Los tratamientos de fondo se basan en métodos no farmacológicos (relajación, autohipnosis, etc.).

PURPOSE:Restraint is often used when administering procedures to children. However, no metrologically scale to measure the restraint intensity had yet been validated. This study validated the metrological criteria of a scale measuring the restraint intensity, Procedural Restraint Intensity in Children (PRIC), used during procedures in children.DESIGN AND METHODS:The PRIC scale performance was measured by a group of 7 health professionals working in a children's hospital, by watching 20 videos of health care procedures. This group included 2 physicians, 1 pediatric resident, and 4 nurses. The intra-class correlation coefficients were calculated to evaluate the inter-rater and test-retest reliability and the construct validity with the correlation between PRIC scale and a numerical rating scale.RESULTS:One hundred and forty measurements were made. Inter-rater and test-retest correlation coefficients were 0.98 and 0.98, respectively. The 2 scales were positively correlated with a Spearman coefficient of 0.93.CONCLUSIONS:This study validated the Procedural Restraint Intensity in Children (PRIC) scale in metrological terms with some limitation. However, there is not gold standard scale to precisely validate the reliability of this tool and this study has been conducted in "experimental" conditions. Nevertheless, this is the first scale measuring the intensity of physical restraint with a metrological validation. The next step will be to validate it in real clinical situations.

Avec pour principe actif un produit d’anesthésie originellement réservé au bloc opératoire, le Mélange équimolaire d’oxygène et de protoxyde d’azote (MEOPA) s’impose peu à peu comme un antalgique efficace et sûr pour prévenir la douleur provoquée par les soins, d’abord dans les services hospitaliers et enfin en secteur de ville. En France, bien qu’autorisé, peu de médecins de ville l’ont intégré dans leur activité. Néanmoins des indications légitimes existent (pansements, sutures, mobilisations…), mais les rares travaux autour de cet usage décrivent quasiment tous un frein financier à son développement. Peu recherché par les praticiens, les connaissances à son sujet semblent modestes et aucune étude d’envergure ne vient documenter son rapport coût/efficacité. Moyennant une « formation MEOPA » attestée au fournisseur, tout praticien de ville peut s’équiper, sous réserve de respecter les consignes du Plan de gestion des risques mis en place par l’Agence nationale de sécurité du médicament. L’impact pour la comptabilité du cabinet comprend une dépense initiale d’installation, et une dépense régulière de consommables. Certains praticiens ayant des honoraires libres le facturent aux patients, alors que la possibilité de déduire cette charge du revenu imposable du cabinet reste méconnue et sous-exploitée. Alors que les autorités de santé souhaitent engager massivement le système de soins vers l’ambulatoire, la création à la nomenclature d’un acte correspondant à l’inhalation de MEOPA est attendue des professionnels, pour pouvoir le facturer à l’Assurance maladie et permettre une équité d’accès au soulagement de la douleur provoquée par les soins.

Aim Benign paroxysmal torticollis (BPT), benign paroxysmal vertigo (BPV), and benign tonic upward gaze (BTU) are characterized by transient and recurrent episodes of neurological manifestations. The purpose of this study was to analyse the clinical relationships between these syndromes, associated comorbidities, and genetic bases. Method In this cross‐sectional study, clinical data of patients with BPT, BPV, or BTU were collected with a focus on developmental achievements, learning abilities, and rehabilitation. Neuropsychological assessment and genetic testing were performed. Results Fifty patients (median age at inclusion 6y) were enrolled. Psychomotor delay, abnormal neurological examination, and low or borderline IQ were found in 19%, 32%, and 26% of the patients respectively. Cognitive dysfunction was present in 27% of the patients. CACNA1A gene mutation was identified in eight families, and KCNA1 and FGF14 mutation in one family respectively. The identification of a CACNA1A mutation was significantly associated with BTU ( p =0.03) and with cognitive dysfunction ( p =0.01). Patients with BPV were less likely to have cognitive dysfunction. Interpretation Children with BPT, BPV, or BTU are at high risk of impaired psychomotor and cognitive development. These syndromes should not be regarded as benign and should be considered as part of the spectrum of a neurodevelopmental disorder. What this paper adds OK Patients with benign paroxysmal torticollis (BPT), benign paroxysmal vertigo (BPV), and benign tonic upward gaze (BTU) have an increased risk of psychomotor delay. These patients also have an increased risk of abnormal neurological examination and cognitive dysfunction. Gene mutations, especially in CACNA1A , were identified in 21% of the families. BPT, BTU, and BPV should not be regarded as benign. BPT, BTU, and BPV should be considered as part of the spectrum of a neurodevelopmental disorder.

The aim of this study was to examine the course of headache diagnosis, headache frequency, anxiety, comorbid depressive symptoms and school absenteeism in adolescents with migraine and tension‐type headaches five years after baseline.

The aim of this study was to examine the course of headache diagnosis, headache frequency, anxiety, comorbid depressive symptoms and school absenteeism in adolescents with migraine and tension-type headaches five years after baseline. We followed a group of 122 children with a mean age of 10.1 (±1.3) years, with headache from a paediatric migraine centre in Paris who had taken part in a previous study from September 2007 to June 2008. This five-year longitudinal study took place in January to June 2012. The measures that were used included demographic variables, headache diagnosis, headache data and a psychological assessment. At the five-year point, about 22% of the children had become headache free, 34% had little to no disability, and 36% had a changed diagnosis. Moreover, a longer history of headache at baseline was associated with a worse evolution of headache at follow-up. Lastly, high depression scores, but not anxiety, were a predictor of more headache disability at follow-up. High depression scores in childhood were a risk factor that was associated with persistence and worsening of headaches in adolescence. This suggests that mental health assessments should be carried out in paediatric headache pain clinics.

The aim of this paper is to validate a French version of the Pediatric Migraine Disability Assessment (Ped- MIDAS). The PedMIDAS is a six-question tool that assesses the disability caused by headaches in school-age children and adolescents. A total of 73 participants completed the questionnaire. Overall, the questionnaire has a good internal consistency ( α = 0.76), test–retest reliability (0.85), and several correlations with headache characteristics, emotional disorders, and quality of life.

The aim of this paper is to validate a French version of the Pediatric Migraine Disability Assessment (Ped- MIDAS). The PedMIDAS is a six-question tool that assesses the disability caused by headaches in school-age children and adolescents. A total of 73 participants completed the questionnaire. Overall, the questionnaire has a good internal consistency (α = 0.76), test–retest reliability (0.85), and several correlations with headache characteristics, emotional disorders, and quality of life.