WHO issues guidance for children living with chronic pain

WHO issued new guidelines on the management of chronic pain in children, including recommendations on physical therapy, psychological therapy and pharmacological management.

The guidance was prepared by Anshu Banerjee, PhD, director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health and Aging, and colleagues. It was developed based on “a systematic review of the quantitative evidence on the benefits and harms of physical, psychological and pharmacological interventions for chronic pain in children,” according to the document.

A second, qualitative review assessed the experiences of patients, families, caregivers and health care providers and how they perceived the benefits and harms of the interventions.

WHO’s Guideline Development Group offered 10 best practices for clinicians treating children with chronic pain, which read, in part:

• Children with chronic pain must be cared for from a biopsychosocial perspective. Pain should not be treated solely as a biomedical problem.

• The biopsychosocial model of pain recognizes pain as a complex, multidimensional experience that is the result of interaction among biological, psychological and social factors. Pain management thus requires a multimodal, interdisciplinary and integrated approach.

• A biopsychosocial assessment is “essential” to inform pain management and planning.

• Children with chronic pain should have an evaluation of any underlying conditions and access to treatment for those conditions, in addition to appropriate interventions for the management of pain.

• Children presenting with chronic pain should be assessed by health care providers who are skilled and experienced in the evaluation, diagnosis, and management of chronic pain.

• Management, whether with physical therapies, psychological or pharmacological interventions, or combinations thereof, should be tailored to the child’s health; underlying condition; developmental age; physical, language and cognitive abilities; and social and emotional needs.

• Care of children with chronic pain should be centered around the child and their family’s values, culture, preferences and resources.

• Families and caregivers must receive timely and accurate information because shared decision-making and clear communication are essential to good clinical care.

• All aspects of the child’s development and well-being must be attended to, including their cognitive, emotional and physical health, as well as the child’s educational, cultural and social needs and goals.

• An interdisciplinary, multimodal approach should be made and tailored to the needs and desires of the child, family and available resources.

The group offered four recommendations for children with chronic pain, which were based on the systematic review:

• Physical therapies may be used either alone or in combination with other treatments.

• Psychological management through cognitive behavioral therapy and related interventions may be used. Psychological therapy may be delivered in person or remotely.

• Appropriate pharmacological management that is tailored to specific indications and conditions may be used.

• Appropriate pharmacological management may include the use of morphine for end-of-life care and must be given by appropriately trained health care providers under the principles of opioid stewardship. Additionally, in children with chronic pain associated with life-threatening conditions, morphine may be given by trained health care workers, again under the principles of opioid stewardship.