首页|Opioid-Sparing in Children with Chronic Pain Who Are Eligible for Palliative Care
Opioid-Sparing in Children with Chronic Pain Who Are Eligible for Palliative Care
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NSTL
Elsevier
As previously fatal diseases of childhood evolve into chronic illnesses of adolescence and young adulthood, some children with palliative care needs develop chronic pain. Many pediatric palliative care teams specialize in pain management, which focuses on improving quality of life by reducing immediate physical suffering, with less expertise in or emphasis on chronic long-term pain management. A child presented for care by a palliative care team in a large quaternary care children's hospital suffered from chronic pain. She was treated with a continuous intravenous (IV) opioid infusion and had a life expectancy of several years or more. With increased awareness of the risks of long-term opioid use, and informed by the best-available evidence for chronic pediatric pain management, we sought an opioidsparing approach in managing the child's pain. This led to challenges in maintaining the therapeutic alliance with the family. For the pediatric palliative care prescriber, appropriate management of chronic pain conditions poses a dilemma for safe prescribing in children with life-limiting diagnoses, but in whom prognosis can be unknowable and goals fluctuating. Balancing a family's fear of chronic suffering vs long-term risks of opioids in children can be complex, and despite best efforts at high-quality communication, can lead to conflict between families, prescribers, and other medical care teams. More coordination is needed between the fields of pediatric chronic pain management and pediatric palliative care, in order to meet best the needs of children who are eligible for care by both.
Thienprayoon, Rachel、Nee, Krista、Mosley, Luke、Tate, Michelle、Meyer, Mark
NSTL
Elsevier
