The brochure Persisting pain in children for policy-makers 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, in particular, policy-makers, medicines regulatory authorities, hospital managers
and health insurance managers. It will allow them to include in their policies the
guidelines’ principle that all patients with pain, including children, should be treated with either
pharmacological or nonpharmacological techniques, irrespective of whether the underlying cause can be identified.
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
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 Single
Convention on Narcotic Drugs, 1961, and its 1972 Protocol. 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. For instance, both the
United Nations Economic and Social Council’s resolution 2005/25 and the 2005 World Health Assembly resolution WHA
58.22 on cancer prevention and control called on countries, and international bodies such
as WHO and the INCB, to remove barriers to the medical use of such analgesics.
Mechanisms behind the impeded access to opioid analgesics and other controlled
medicines are of various natures. They include legal and policy issues, and several
educational issues at all levels, from patients and their families to physicians and policy-makers. All
policy-makers have an important role to play in improving the current unfortunate situation.
WHO recommends that authorities and policy-makers responsible for expanding pain
relief treatment in the health system assess national control regulations for the
production, procurement, storage, distribution, prescription, dispensing and administration of opioid
analgesics (and other controlled medicines).
Countries that have very strict laws and policies that do not allow ready access
to pain treatment should endeavour to make them less restrictive and more practicable. WHO has
developed guidelines that elaborate on the policy aspects of improving access to ensure
the balance between the adequate availability for medical and scientific purposes while
simultaneously preventing abuse, diversion and trafficking (2).
This brochure provides background information on the treatment of pain in
children that can be helpful for ensuring adequate access to pain treatment. For more detailed
information and additional references we refer to the formal pain guidelines document. In case
of any discrepancy between this brochure and the guidelines document, the
guidelines document should be the reference.
Similar brochures are published with highlights for physicians and nurses, and