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Pharmacological approaches to pain. 2: Simple analgesics and opioids 

Pharmacological approaches to pain. 2: Simple analgesics and opioids
Pharmacological approaches to pain. 2: Simple analgesics and opioids

Ross Drake

, Stefan J. Friedrichsdorf

, and Richard D. W. Hain

Page of

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date: 20 February 2020

This chapter will consider the pharmacological management of pain in children with life-limiting conditions, and wherever possible will draw on the pool of knowledge obtained from studies of children. The choice of analgesic drug(s) (see Figure 21.1 ) is made on the basis of assessment of pain severity. The World Health Organization (WHO) approach was based on the assumption that, for most children with cancer, pain will gradually increase as their illness progresses, and that this increase in pain intensity should be matched by the stepwise introduction of progressively stronger analgesics. Fairly rapid escalation of pain is usual for children with cancer, but is typically slower and less consistent for those with pain of non-malignant origin. One aim of this model was to avoid cycling through alternative medications of the same potency rather than selecting a stronger class of drug. Thus if a step 1 non-opioid analgesic is no longer effective, a minor opioid in step 2 should be added. Severe pain requires step 3, namely a strong opioid in the same class as morphine. Of course a child with severe pain should not be condemned to slow progress up the ladder — a strong opioid should be commenced immediately.

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