The World Health Organization (WHO) has issued new guidelines for managing chronic pain in children and highlighted the importance of opioid stewardship to address worldwide concerns about harms arising from misuse of these pain medicines.
Little is known about the global burden of chronic pain in children, but available studies suggest that around one-quarter to one-third of children live with it, often as a symptom of other health conditions such as cancer or sickle cell disease.
Chronic pain, classed as pain that persists or recurs for longer than three months, is a significant public health problem and a leading cause of morbidity in children globally. Access to pain management is vital for patients’ quality of life, and children who live with chronic pain often experience higher levels of physical disability, anxiety, depression, sleep problems, and poor academic performance.
Managing chronic pain in children
The new WHO Guidelines recommend physical, psychological and pharmacological interventions for pain relief in children aged 0-19 years, aiming to help develop and implement national and local policies, regulations, pain management protocols, and best practices for pain relief. It notes that care for children with chronic pain must be child- and family-centred and included in all universal health coverage schemes.
The recommendations cover three areas, including physical therapy, psychological therapy, and pharmacological management, which may include the use of morphine for end-of-life-care or when chronic pain is associated with life-limiting conditions.
Opioid stewardship
There are currently worldwide concerns about the use of highly addictive opioids to manage pain, and the WHO highlights the importance of opioid stewardship to address the issue.
The guidelines state that: ‘The goal of opioid stewardship is to protect and optimize individual and population health. Specifically, the goals are to ensure the rational use of opioids: meeting the needs of individuals who require pain control, while minimizing harms to the individual and to other persons and populations. These harms include those that may arise from opioid overuse, misuse and diversion.’
It highlights that the practices of opioid stewardship in children are four-fold, noting that:
- Opioids must only be used for appropriate indications and prescribed by trained providers, with careful assessments of the benefits and risks
- The use of opioids by individuals, their impact on pain and their adverse effects must be continuously monitored and evaluated by trained providers
- The prescribing provider must have a clear plan for the continuation, tapering or discontinuation of opioids according to the child’s condition. The child and family must be apprised of the plan and its rationale
- There must be due attention to procurement, storage and the disposal of unused opioids
The guideline also includes 10 best practice statements which apply to all aspects of the clinical care of a child with chronic pain, including that children with chronic pain and their families and caregivers must be cared for from a biopsychosocial perspective, recognising pain as a complex multidimensional experience resulting from biological, psychological and social factors instead of only treating pain as simply a biomedical problem, for example.
