Chronic pain management in children and young people

New guidelines on chronic pain in children focus on physical, psychological and pharmacological interventions

Essential information

Chronic pain – defined as persisting or recurring for longer than three months – is a significant global public health problem for children, with a negative impact on their emotional, physical and social development and function, says the World Health Organization (WHO).

There is also a significant effect on the lives of their families and caregivers.

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While it is difficult to determine its prevalence accurately, studies cited by the WHO suggest that chronic pain is experienced by about one quarter to one third of children, with about one in 20 having moderate to high levels of pain-related disability.

The charity Pain Concern says about 15% to 35% of school age children may be affected, yet children’s pain is often neglected.

What’s new?

In January, the WHO issued new guidelines on the management of chronic pain in children that provide evidence-informed recommendations focusing on physical, psychological and pharmacological interventions.

Key recommendations

• Treat children in chronic pain and their families from a ‘biopsychosocial’ perspective – pain should not be treated simply as a biomedical problem, and its management needs a multimodal, interdisciplinary and integrated approach.
• Children with chronic pain should have a thorough evaluation of any underlying conditions, with access to appropriate treatment and interventions to manage their pain.
• Children presenting with chronic pain should be assessed by healthcare providers who are skilled and experienced in the evaluation, diagnosis and management of chronic pain.
• Care should be child- and family-centred. This includes being tailored to the family’s values, culture, preferences and resources, alongside supporting children and their families to play an active role in care through informed and shared decision-making.
• The child’s educational, cultural and social needs and goals must be addressed as part of their care management plan.
• Use of opioids should be rational and cautious, with constant monitoring and evaluation and a clear plan for continuing, tapering or discontinuation.

Symptoms

Great Ormond Street Hospital explains that chronic pain symptoms can be varied and may be described as burning, tingling, shooting or a numb sensation.

• RELATED: Fundamentals of chronic pain in children and young people. Part 1

Also common is extreme sensitivity to touch, heat, cold and temperature.

Children may react to pain by not moving the painful area and doing less physical activity, leading to reduced muscle strength and stamina, alongside increased feelings of frustration and hopelessness.

How you can help children and young people

Remember that children may be at risk from under-diagnosed and untreated chronic pain. Make sure you ask about pain, including its impact on the child’s life.

• RELATED: Fundamentals of chronic pain in children and young people. Part 2

Seek specialist advice and consider referrals to other healthcare professionals, including your organisation’s pain service. You can also play a key role in explaining more about the pain and its treatment to the child and their family. This improves understanding, ensuring they can become more involved in making informed decisions about care.

Help the child and their family set realistic goals about pain relief, explaining that being totally pain free may be unlikely.

Expert comment

Jane Noyes, professor in health and social services research and child health, Bangor University, Wales

‘This guidance provides clear recommendations on the best ways of managing children’s chronic pain in different contexts.

‘Its production followed a systematic research process, including undertaking a suite of quantitative and qualitative reviews on the effectiveness of interventions, alongside the acceptability and feasibility of implementing them from the perspective of children, families and healthcare professionals.

‘Many experts in children’s pain management contributed to the guideline panel, which developed the recommendations using robust methods.

‘Most of the evidence came from high income countries, so the findings and recommendations are relevant to children’s nurses practising in the UK.

‘Although the amount of evidence has increased substantially in the past decade, the voice of the child does not yet feature sufficiently prominently and this needs to be addressed.’

Lynne Pearce is a health journalist

Find out more

• Great Ormond Street Hospital for Children – Chronic Pain
• Pain Concern – Families and Children
• World Health Organization (2020) Guidelines on the Management of Chronic Pain in Children