Douleur de l'enfant - Recommandations OMS 2012

WHO
guidelines on
the pharmacological
treatment of persisting
pain in children with
medical illnessesWHO
guidelines on
the pharmacological
treatment of persisting
pain in children with
medical illnessesWHO Library Cataloguing-in-Publication Data
Persisting pain in children package: WHO guidelines on the pharmacological
treatment of persisting pain in children with medical illnesses.
Contents: WHO guidelines on the pharmacological treatment of persisting pain in children with medical
illnesses - Three brochures with important information for physicians and nurses; pharmacists; policy-makers
and medicines regulatory authorities, hospital managers and health insurance managers - Dosing card - Pain
Scale for children (4 years of age and up) - Pain Scale for children (6 - 10 years) - Wall chart for waiting rooms
1.Pain-drugtherapy.2.Pain-classifcation.3.Painmeasurement.4.Analgesics,Opioid.5.Drugs,Essential.
6.Drug and narcotic control. 7.Palliative care. 8.Child. 9.Guidelines. I.World Health Organization.
ISBN9789241548120 (NLMclassifcation:WL704)
© World Health Organization 2012
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Printed in (country name)contents
AcKnoWLeDGeMents ..................................................................................6
Donors .........................................................................................................................................6
ABBReVIAtIons AnD AcRonYMs ................................................................. 7
GLossARY .................................................................................................... 8
eXecUtIVe sUMMARY ................................................................................ 10
Clinical and policy recommendations...........................................................................................10
Future research...........................................................................................................................10
Reading guide 11
IntRoDUctIon .......................................................................................... 13
1. cLAssIFIcAtIon oF PAIn In cHILDRen .................................................. 16
1.1 Introductiontoclassifcationofpain ................................................................................... 17
1.2 Painclassifcationsystems ..................................................................................................18
1.2.1Pathophysiologicalclassifcation .............................................................................. 18
1.2.2Classifcationbasedonpainduration ........................................................................ 20
1.2.3Etiologicalclassifcation ............................................................................................ 21
1.2.4Anatomical ........................................................................................... 21
1.3 Causesandclassifcationofpainassociatedwithspecifcdiseases ....................................... 23
1.3.1CausesandtypesofpaininchildrenwithHIV/AIDS ....................................................23
1.3.2andtypesofpaininwithcancer .......................................................24
1.3.3Causesandtypesofpaininchildrenwithsicklecelldisease ......................................25
2. eVALUAtIon oF PeRsIstInG PAIn In tHe PAeDIAtRIc PoPULAtIon ....... 26
2.1 Clinicalexamination:painhistoryandphysicalexamination ...............................................27
2.2 Expressionofpainbychildrenandappropriatepainassessmentmeasures ..........................29
2.3 Documentationofpain:theuseofpainmeasurementtools ................................................30
2.4 Defningcriteriaandselectingapaintoolinclinicalsettings ......................... 33
2.5 Assessmentofotherparametersinchildrenwithpersistingpain .........................................34
2.6 Overcoming the challenges of assessing persisting pain in children .....................................35
3. PHARMAcoLoGIcAL tReAtMent stRAteGIes
PATIENT-LEVEL GUIDELINES FOR HEALTH PROFESSIONALS ..................................................36
3.1 Principlesforthepharmacologicalmanagementofpain .....................................................37
3.2 Treatingpainusingatwo-stepstrategy ..............................................................................38
3.2.1Thefrststep:mildpain ............................................................................................38
3.2.2Thesecondstep:moderatetoseverepain ..................................................................38
3.2.3Considerationofthetwo-stepapproach .....................................................................39
1<3.3 Treatingpainatregularintervals .......................................................................................40
3.4painbytheappropriateroute ...............................................................................40
3.5 Tailoringpaintreatmenttotheindividualchild ..................................................................40
3.5.1Non-opioidanalgesics ..............................................................................................40
3.5.2Opioidanalgesics .....................................................................................................41
3.6 Strongopioidsessentialinpaintreatment ..........................................................................42
3.7 Choiceofstrongopioids ....................................................................................................42
3.8 Immediate-releaseandprolonged-releaseoralmorphine ....................................................43
3.9 Opioidswitching ................................................................................................................44
3.10 Routesofadministration 45
3.11 Treatmentofbreakthroughpain .........................................................................................46
3.12 Tolerance,withdrawalanddependencesyndrome ...............................................................46
3.13 Opioidoverdose 47
3.14 Adjuvantmedicines ...........................................................................................................50
3.14.1Steroids ..................................................................................................................50
3.14.2Bonepain ...............................................................................................................50
3.14.3Neuropathicpain ....................................................................................................51
3.14.4Painassociatedwithmusclespasmandspasticity ....................................................52
3.15 Researchagenda 53
4. IMPRoVInG Access to PAIn ReLIeF In HeALtH sYsteMs ....................... 54
4.1 The right to health, the right to be spared avoidable pain ...................................................55
4.2 International regulations on opioid analgesics ....................................................................55
4.3 Dimensionsofanationalpaintreatmentpolicy ..................................................................56
4.4 Financing pain relief within the national system .................................................................56
4.5 Estimatingneedsforpainrelief .........................................................................................57
4.6 Saving resources by treating pain .......................................................................................58
4.7 Pain management coverage ...............................................................................................59
4.8 Human resources for pain management .............................................................................59
4.9 What treatment should be available ...