Page 95 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

Risks/benefits
Benefits
The panel placed a high value on effective use of adequate doses of the chosen opioid.
Risks
Risks are well described and considered to be manageable. Access to age-appropriate dose
conversion table for different opioids is necessary for safe switching.
Uncertainty: none.

Values and acceptability
In favour
The panel placed high value on treating rather than not treating pain and providing an alternative
when response is inadequate and side-effects are intolerable.
Against
None
Uncertainty: none.

Cost
Alternative opioids to morphine might be more expensive. However, there are regional variations in
costs and some alternatives to morphine may even be cheaper.
Uncertainty: none.

Feasibility
Access to an age-appropriate dose conversion table for different opioids is necessary for safe
switching.
Uncertainty: yes.

Policy and research agenda
The panel requests an update of the 2004 Cochrane review on opioid switching, including data from
children, if available. Opioid rotation policies lend themselves to investigation by prospective trials.
Such research is encouraged. Research on dose conversion in different age groups is necessary.

A2.2.7 Routes of administration

Clinical question
In children with persisting pain due to medical illnesses, should the intravenous, subcutaneous,
intramuscular, transdermal, rectal, intranasal routes be used in preference to the oral route for effective
and safe pain control?

Recommendations
13. Oral administration of opioids is the recommended route of administration.
14. The choice of alternative routes of administration when the oral route is not available should be
based on clinical judgement, availability, feasibility and patient preference.

15. The intramuscular route of administration is to be avoided in children.
Strong recommendations, very low quality of evidence

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