Page 91 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

Values and acceptability
In favour
The panel valued access to effective treatment of pain in children.
Against
None
Uncertainty: none.

Cost
Although access to strong opioids is variable, price is not generally a significant barrier for a number
of strong opioids.
Uncertainty: none.

Feasibility
Access to strong opioids for medical use remains a challenge worldwide. However, the rational
use of opioid analgesics in countries with limited financial and human resources is feasible and
recommended.
Uncertainty: none.

Policy agenda
Countries should review, and if necessary, revise their policies and regulations to ensure availability
and accessibility of opioid analgesics for the relief of moderate to severe pain in children as provided
for in the preamble of the Single Convention on Narcotic Drugs, 1961.

A2.2.4 Choice of strong opioids

Clinical question
In children with persisting pain due to medical illnesses, what is the evidence to support the use of
morphine as a gold standard for strong opioids as compared to the use of other strong opioids (in
particular fentanyl, hydromophone, oxycodone and methadone) in order to achieve rapid, effective and
safe pain control?

Recommendations
5. Morphine is recommended as the first-line strong opioid for the treatment of persisting moderate to
severe pain in children with medical illnesses.
6. There is insufficient evidence to recommend any alternative opioid in preference to morphine as the
opioid of first choice.
7. Selection of alternative opioid analgesics to morphine should be guided by considerations of safety,
availability, cost and suitability, including patient-related factors.
Strong recommendations, low quality of evidence

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