Page 97 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

Recommendations
16. A careful distinction between end-of-dose pain episodes, incident pain related to movement or
procedure, and breakthrough pain is needed.

17. It is strongly recommended that children with persisting pain receive regular medication to control
pain and also appropriate medicines for breakthrough pain.
Strong recommendations, very low quality of evidence

There is insufficient evidence to recommend a particular opioid or route of administration for
breakthrough pain in children. There is a need to make an appropriate choice of treatment modality
based on clinical judgement, availability, pharmacological considerations and patient-related factors.

Domains and considerations

Quality of evidence
The panel noted that alternative formulations of opioids given by alternative routes of administration
have been investigated for breakthrough pain in adults, but at present there are no data to support
their use in children.
Uncertainty: yes.

Risks/benefits
Benefits
Unknown
Risks
The risk of high potency opioids via alternative routes of administration has not been investigated in
children with persisting pain.
Uncertainty: yes.

Values and acceptability
In favour
It is important that children with persisting pain receive regular medication to control pain, and are
afforded an appropriate strategy for breakthrough pain.
Against
None.
Uncertainty: none.

Cost
New formulations using alternative routes of administration to oral are expected to be more costly.
Uncertainty: yes.

Feasibility
Unknown.
Uncertainty: yes.

Research agenda
Research regarding the optimal choice of opioids and routes of administration for rapidly effective
relief of breakthrough pain is needed.

> 94