The World Health Organization (WHO) has updated guidelines for the management of pain in seriously ill children, including those in hospice and palliative care. This action replaces previous guidelines issued in 2012.
The WHO guidelines are designed to help health care providers and governments develop scientifically current protocols for addressing pain in children that lasts longer than three months. The international agency called chronic pain a “significant public health problem and a leading cause of morbidity in children globally.”
“Pain is a complex multidimensional experience, the result of the interaction of many biological, psychological and social factors. Pain management in turn requires a multimodal, interdisciplinary approach,” Bernadette Daelmans, M.D., told Hospice News. “The guideline explores the perceived benefits of psychological therapies which include improved sleep, mood, quality of life and family communication, and decreased anxiety.”
Daelmans leads WHO’s work on child health and development within the agency’s Department of Maternal, Newborn, Child and Adolescent Health and Aging.
The new document is titled “WHO Guidelines on the management of chronic pain in children provide recommended physical, psychological and pharmacological interventions for pain relief in children aged 0-19 years.” The agency expects to release the document by Feb. 1.
Pain management is a cornerstone of hospice and palliative care and can have a substantial impact on patients’ well being and their families’ satisfaction with the services their loved one received. A 2014 study found patients and families view pain and symptom management as their top priority related to quality of hospice care. With consumers and referral organizations paying increased attention to publicly reported quality data, dissatisfaction with pain treatment can hurt an organization’s bottom line as well as patients’ quality of life.
WHO’s recommendations include three kinds of interventions: physical therapy, psychological therapy, and pharmacological management, noting that this could include the use of morphine for end-of-life-care or when chronic pain is associated with life-limiting conditions.
WHO defines the terms “end-of-life-care” as palliative care for people in the final weeks or months of life to die with dignity and “life-limiting conditions” as illnesses for which no cure exists and an early death is expected, but not imminent.
The agency incorporated information about appropriate opioid stewardship within the guidelines. Opioid stewardship refers to strategies and interventions for the appropriate procurement, storage, prescribing and use of prescribed opioids, as well as the disposal of unused opioids.
Data are scarce on the prevalence of chronic pain in pediatric patients. According to WHO, current literature suggests that nearly one-quarter to one-third of children experience it. Chronic pain is often associated with a long list of conditions that includes cancer, sickle-cell disease, diabetes and arthritic conditions, among others. As WHO has noted, pain has psychosocial dynamic as well as physical, and this also needs to be addressed.
“Following a holistic approach to palliative care, the guideline provides best practice statements which apply to all aspects of clinical care across physical, psychological and pharmacological interventions,” Daelmans said. “This includes the safe and appropriate use of opioids, taking into account the needs and expectations of the children and their families.”