BSCOS 2022 Annual Meeting: The Upper Limb in Children

News and presentations from today's BSCOS conference focusing on unravelling the secrets of the upper limb in a child.

Chronic Pain in Children

Dr Nick Wilkinson Paediatric Rheumatologist
Guy’s and St Thomas’ NHS Foundation Trust

Dr Wilkinson discussed the importance of giving patients control to cope with their response to pain, he started by saying; "pain is strange, because the brain is strange". He said everyone's experience of pain is different and it's important to understand the context of the situation as that will impact on the pain experience. He outlined key points:

- pain is common it's just an alarm, the louder it is doesn't tell us anything
- pain score is not a marker of tissue damage
- pain is not the vital fifth sign

He went on to question; "so why do we have pain?" Saying it helps us to learn and protect ourselves. Responding to pain our brain works in a controlled hallucination. We have a perception of the world that we test; a predictive model that the other sensations feed into.

On managing pain, Dr Wilkinson said it's important to listen to the patient story and offer reassurance, he said feeling heard is enormously powerful. It's important to start to normalise, the pain won't change, we have to affect function. The role of pain medication is limited even for the most disabling pain but we can use it for other things/threats like anxiety, fatigue, nausea, to enable patients a sense of control and self-management so that they can normalise. NICE guidelines recommend psychology i.e. CBT, physical activity programmes i.e. for knee osteo arthritis, acupuncture (although no studies in children) etc.

Mercy Ships

Miss Rachel Buckingham Consultant Paediatric Orthopaedic Surgeon
Oxford University Hospitals NHS Foundation Trust

Two out of three people worldwide do not have access to safe, timely and affordable surgery. Together we can change this. Mercy Ships seeks to transform individuals and strengthen healthcare systems, leaving a lasting legacy in every nation we visit. Bringing hope and healing through hospital ships and in-country training has been the mission of Mercy Ships for more than 40 years. Thanks to our supporters, those suffering from painful and preventable diseases can find the care they desperately need. To date, Mercy Ships has worked in more than 55 developing countries, providing services valued at more than £1.3 billion, directly benefitting more than 2.8 million people. The global impact of COVID-19 has touched everyone and deepened the surgery crisis in the least developed countries. The need for this work is more paramount than ever.