European Stars and Stripes (Newspaper) - December 22, 1985, Darmstadt, Hesse                                Sunday. December 22. 1985 the stars and stripes Page 17 trying to relieve children s suffering6 project pain by Daniel q. Haney associated press Ore than the parents who stare into their Clear plastic tents More than the doctors and nurses who tend the tubes and machines that feed and medicate them and breathe for them the children s companion is pain. They have been burned Many of them from the hair of their Heads to the soles of their feet. Just a few years ago. Youngsters so tragically maimed by fire would surely have died. Now they often survive but at a tremendous Price in agony. Everything hurts says or. Stan k. Szy Helbein. Every single  when Szy Felbein looks into the sterile plastic tents at the shrines Burns Institute in Boston where he is chief of Anaesthesiology he sees failure. His humane a so perfected in the operating room often fails to relieve the misery of burned children s waking hours. Medical technology restores the victims fluids. It outwits the bacteria that invade them. It salvages and even crafts skin to cover their exposed flesh. It gives then Back their lives. But it does not Stop the pain. Szy Felbein believes this torment could be vastly reduced that pain can be conquered just As infections can be. But the Effort to separate Healing from misery requires a commitment to understanding the origins of pain and the strategies that circumvent it he says. In the special Case of burned children that Effort has been neglected Szy Helbein says. He blames his profession his colleagues widespread if unconscious belief that somehow children Don t remember pain indeed Don really even feel it and thus Don t need analgesics to control it. Szy Felbein has been listening to children s screams for most of his professional life. He has even recorded them. Perhaps in those cries there is a language of pain and a skillful translator could learn to distinguish True pain from fear. Children Are my very special concern says Szy Helbein. He is a Large Man Burly and forceful with a voice tinged by the cadence of Poland where he was born. To be honest he goes on. I be made some enemies among paediatricians and surgeons by just simply defending those Little kids by saying there is totally inadequate pain  now Szy Felbein and two colleagues at shrines or. Patricia f. Osgood a pharmacologist and or. Daniel b. Carr an endocrinologist. Have begun project pain a research program they Hope someday will relieve the suffering of burned children. In tha methodical Way that science moves they have begun at the very beginning looking for ways to measure the sensation of pain itself. They have found that blood Levels of natural painkillers known As endorphins Are directly linked to children s pain. The higher their bodies production of these chemicals the less pain they feel this work published in the latest Issue of the journal pain is a first step. It is a step they believe that will eventually let doctors measure pain As they do temperature and blood pressure. To Deal with patients on a Day to Day basis even the most dedicated nurses have to Block Many feelings says Nancy Atchison. A pain research nurse it s a survival technique. Obviously it s very difficult for both. This ordeal is necessary for the patients recovery. The patients complain and the nurses say. You can t be feeling that much  three years ago a nationwide Survey sponsored by the National institutes of health was conducted among hospitals that treat Burn victims. Among the questions How much analgesics Are used the thing that startled  snick Osgood. Was that they More often gave children nothing at  said Szy Felbein most of the physicians or nurses made a Flat nurse explains pain thermometer to client at Huston s shrines Burns Institute. Statement children did not need any analgesia this is not unusual. They will Tell you that children always cry. They always scream. How do we know whether they have pain or not in order probably to cure our own consciences we say they Don t have pain even when the will exists to relieve the pain of dressing changes and other unpleasant procedures there Are no easy ways to do this. The simplest solution would be to simply put the children to sleep during the experience. But that s impossible for the youngsters must eat to live. Because they have virtually no stun. They lose tremendous amounts of heat. So to keep from digesting their own bodies they must take in lots of calories to maintain their body temperatures. However people must fast eight Houtos to empty their stomachs before they can be Given general aesthetics. Since there Are two dressing changes a a that leaves Little time for food. Even if the patients could be kept entirely on intravenous feeding. There is another problem. Anaesthesiologist a Are not scheduled for routine work at night when they would be needed Tor the Day s second dressing change. Another possibility is narcotic painkillers. But Here a difficulty is fear of overdoses and malpractice suits. A Standard pharmacology textbook lists recommended doses of these drugs for people of different body weights. However not everyone s needs Are the same. Szy Felbein says that one child May require 10 times the recommended dose while another might need Only half. Yet physicians Are reluctant to stray from the Book. Everybody just follows that  he said. If you double the dose and something happens to the patient there Are terrible Legal aspects. Practically any lawyer can say this is malpractice " since medical people complain that they cannot distinguish screams of pain from cries of fear. The researchers Are looking for an objective measure of the sensation. Adult pain and analgesic studies Are very Well established but virtually nothing has been done with  Osgood said. Our first task was to set up methods Lor trying to assess  eventually the researchers built a big red thermometer so children could separate mild pain from intense. On this scale Zero represented no pain. Ten was pain As bad As it can be. Having such a pain Index could someday help physicians prescribe the Correct amount of painkillers to ease the misery of Burn treatment and other dim cult therapy especially in those who Are Young or cannot speak