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Therapeutic indications include the delivery of local anesthetics for pain relief and the delivery of corticosteroids for suppression of inflammation; however, only a tiny percentage (30%) of pediatric studies investigating pain modulation have found efficacy for treating pediatric non–dietary conditions such as irritable bowel syndrome or chronic constipation [11,18]. There have been cases of success in treating pediatric symptoms with corticosteroids including constipation and irritable bowel syndrome [5,9,14]. Pediatricians who report success with corticosteroids in treating pediatric non–dietary conditions may do so because of the presence of a parent-patient relationship or because of the patient's ability to comply with the treatment program. In general, more trials have failed to demonstrate efficacy for pediatric non–dietary conditions, including irritable bowel syndrome or colic, and more than half of pediatric studies do not provide data on this issue [6]. It is unknown whether treatment with an opioid receptor antagonist (ORA) enhances efficacy with corticosteroids. Evidence-based guidelines for treatment of pediatric pain There are no specific criteria for assessing pain in pediatric patients and guidelines are currently lacking. In the UK, for example, the International Pediatric Pain Society has used a series of criteria to identify areas of uncertainty regarding pediatric pain [4,9]. A detailed description of how pain assessment criteria were developed and used is available in [4,3]. One of the most used pain-related criteria in European and North American guidelines is the International Quality of Life (IQN) questionnaire, in which children are asked about an array of symptoms and feelings including anxiety, fatigue, insomnia, sleep disturbance, physical pain, and social, social, and psychological pain [7]. The European Quality of Life (QOL) questionnaire has been included in more than 25 international surveys and has been evaluated and validated many times for its ability to diagnose and characterize pain in children [7]. It has been estimated that the QOL scale provides an accuracy rates of 91–98% [7]. Evidence-based guidelines for use of pain assessment criteria have also been developed by the European Pediatric Pain Coordinating Committee and the Pain Subcommittee of the American Academy of Pediatrics [3]. These guidelines, reviewed recently in Pediatrics [18], provide guidance on how they may be used to diagnose pediatric pain and provide guidelines regarding the manner in which pain can be treated. Although no specific guideline has been written, it would be helpful for clinicians to learn all the different criteria used to define pain in children when selecting treatment options for pediatric pain. For example, the American Academy of Pediatrics suggests that clinicians use the following criteria for Related Article:

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Letrozole ovulation, letrozole ovulation induction side effects
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