This chapter sets out some of the principles of pharmacological pain management in children’s palliative care. The fundamental precept that links them is that of simplicity. The default intervention should always be the simplest one that will achieve the desired therapeutic effect. This is arguably an important principle for good clinical care generally, but it becomes paramount during the palliative phase, when the focus is on carefully weighing the potential benefit of any intervention against its burden. Treatment will inevitably be made more complex by polypharmacy, by the use of intravenous, epidural, or intrathecal routes rather than enteral, transcutaneous, or subcutaneous ones, or by the prescription of esoteric medications that are unfamiliar to those providing bedside care. The WHO pain ladder was the first rational and systematic approach to the management of pain in palliative medicine in adults or children. Its aim was to provide logical and simple structure through a set of principles — not to be exhaustive or to provide detailed guidelines. Its intention was to teach, rather than to instruct. Now, 25 years after its publication, the WHO approach remains the yardstick against which new interventions in the management of pain in palliative medicine should be measured. However, this does not mean that the guidelines should not be subjected to critical evaluation and review. Such scrutiny is particularly important when applying them to children, who were not the population for whom the original guidelines were designed.
Chapter. 15102 words. Illustrated.
Subjects: Paediatrics ; Palliative Medicine ; Pharmacology ; Pain Medicine
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