The brochure Persisting pain in children for physicians and nurses offers concise information which is extracted from the WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses unless otherwise stated.

These new WHO guidelines outline basic principles, clinical recommendations and health system recommendations. This brochure highlights selected issues which are essential for all health-care professionals who treat or care for children with pain.

The WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses address the pharmacological treatment of persisting pain, including cancer pain. As such, it replaces the previous guidelines Cancer pain and palliative care in children, which exclusively covered cancer pain. The new guidelines on persisting pain in children are the first of a series of three guidelines documents on all types of pain in both adults and children. The topics of the other two guidelines will be "persisting pain in adults" and "acute pain". The basic principle of the guidelines is that all patients with pain, including children, should be treated with either pharmacological or non-pharmacological techniques, irrespective of whether the underlying cause can be identified.

The World Health Organization (WHO) estimates that around 5.7 billion people live in countries where moderate and severe pain is not adequately treated. Data from the International Narcotics Control Board (INCB) for 2009 show that more than 90 percent of the global consumption of strong opioids occurred in Australia, Canada, New Zealand, the United States of America, the United Kingdom and several other European countries. This means that their availability was very limited in many countries and regions. Over 80% of the world population will have insufficient analgesia.

Medicines for opioid analgesia, such as morphine, are subject to the international drug control conventions and as a result, the focus has historically been on prevention of misuse, dependence and diversion while medical access has been neglected. In recent years, growing recognition of the legitimate use of these substances for medical and scientific purposes has resulted in a shift in emphasis.

Mechanisms behind the impeded access to opioid analgesics and other controlled medicines are of various natures. They include legal and policy issues, and various educational issues at all levels, from patients and their families to physicians, pharmacists and policy-makers. Doctors and nurses have an important role to play in overcoming these barriers and expanding pain relief treatment to all patients who need treatment.

This brochure provides background information on the treatment of pain in children that can be helpful to doctors and nurses for ensuring adequate access to pain treatment. For more detailed information and additional references we refer to the formal guidelines document. In case of any discrepancy between this brochure and the guidelines document, the guidelines document should be the reference.

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