Douleur de l'enfant - Recommandations OMS 2012

Oms

Description

01/01/2012

Sujets

• Douleur

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• Publié par: sfpediatrie
• Publié le: 01 janvier 2012
• Nombre de lectures: 45
• Licence : En savoir +
  Paternité, pas d'utilisation commerciale, partage des conditions initiales à l'identique
• Langue: Français
• Poids de l'ouvrage: 1 Mo

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WHO
guidelines on
the pharmacological
treatment of persisting
pain in children with
medical illnessesWHO
guidelines on
the pharmacological
treatment of persisting
pain in children with
medical illnessesWHO Library Cataloguing-in-Publication Data
Persisting pain in children package: WHO guidelines on the pharmacological
treatment of persisting pain in children with medical illnesses.
Contents: WHO guidelines on the pharmacological treatment of persisting pain in children with medical
illnesses - Three brochures with important information for physicians and nurses; pharmacists; policy-makers
and medicines regulatory authorities, hospital managers and health insurance managers - Dosing card - Pain
Scale for children (4 years of age and up) - Pain Scale for children (6 - 10 years) - Wall chart for waiting rooms
1.Pain-drugtherapy.2.Pain-classifcation.3.Painmeasurement.4.Analgesics,Opioid.5.Drugs,Essential.
6.Drug and narcotic control. 7.Palliative care. 8.Child. 9.Guidelines. I.World Health Organization.
ISBN9789241548120 (NLMclassifcation:WL704)
© World Health Organization 2012
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of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any
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Printed in (country name)contents
AcKnoWLeDGeMents ..................................................................................6
Donors .........................................................................................................................................6
ABBReVIAtIons AnD AcRonYMs ................................................................. 7
GLossARY .................................................................................................... 8
eXecUtIVe sUMMARY ................................................................................ 10
Clinical and policy recommendations...........................................................................................10
Future research...........................................................................................................................10
Reading guide 11
IntRoDUctIon .......................................................................................... 13
1. cLAssIFIcAtIon oF PAIn In cHILDRen .................................................. 16
1.1 Introductiontoclassifcationofpain ................................................................................... 17
1.2 Painclassifcationsystems ..................................................................................................18
1.2.1Pathophysiologicalclassifcation .............................................................................. 18
1.2.2Classifcationbasedonpainduration ........................................................................ 20
1.2.3Etiologicalclassifcation ............................................................................................ 21
1.2.4Anatomical ........................................................................................... 21
1.3 Causesandclassifcationofpainassociatedwithspecifcdiseases ....................................... 23
1.3.1CausesandtypesofpaininchildrenwithHIV/AIDS ....................................................23
1.3.2andtypesofpaininwithcancer .......................................................24
1.3.3Causesandtypesofpaininchildrenwithsicklecelldisease ......................................25
2. eVALUAtIon oF PeRsIstInG PAIn In tHe PAeDIAtRIc PoPULAtIon ....... 26
2.1 Clinicalexamination:painhistoryandphysicalexamination ...............................................27
2.2 Expressionofpainbychildrenandappropriatepainassessmentmeasures ..........................29
2.3 Documentationofpain:theuseofpainmeasurementtools ................................................30
2.4 Defningcriteriaandselectingapaintoolinclinicalsettings ......................... 33
2.5 Assessmentofotherparametersinchildrenwithpersistingpain .........................................34
2.6 Overcoming the challenges of assessing persisting pain in children .....................................35
3. PHARMAcoLoGIcAL tReAtMent stRAteGIes
PATIENT-LEVEL GUIDELINES FOR HEALTH PROFESSIONALS ..................................................36
3.1 Principlesforthepharmacologicalmanagementofpain .....................................................37
3.2 Treatingpainusingatwo-stepstrategy ..............................................................................38
3.2.1Thefrststep:mildpain ............................................................................................38
3.2.2Thesecondstep:moderatetoseverepain ..................................................................38
3.2.3Considerationofthetwo-stepapproach .....................................................................39
1<3.3 Treatingpainatregularintervals .......................................................................................40
3.4painbytheappropriateroute ...............................................................................40
3.5 Tailoringpaintreatmenttotheindividualchild ..................................................................40
3.5.1Non-opioidanalgesics ..............................................................................................40
3.5.2Opioidanalgesics .....................................................................................................41
3.6 Strongopioidsessentialinpaintreatment ..........................................................................42
3.7 Choiceofstrongopioids ....................................................................................................42
3.8 Immediate-releaseandprolonged-releaseoralmorphine ....................................................43
3.9 Opioidswitching ................................................................................................................44
3.10 Routesofadministration 45
3.11 Treatmentofbreakthroughpain .........................................................................................46
3.12 Tolerance,withdrawalanddependencesyndrome ...............................................................46
3.13 Opioidoverdose 47
3.14 Adjuvantmedicines ...........................................................................................................50
3.14.1Steroids ..................................................................................................................50
3.14.2Bonepain ...............................................................................................................50
3.14.3Neuropathicpain ....................................................................................................51
3.14.4Painassociatedwithmusclespasmandspasticity ....................................................52
3.15 Researchagenda 53
4. IMPRoVInG Access to PAIn ReLIeF In HeALtH sYsteMs ....................... 54
4.1 The right to health, the right to be spared avoidable pain ...................................................55
4.2 International regulations on opioid analgesics ....................................................................55
4.3 Dimensionsofanationalpaintreatmentpolicy ..................................................................56
4.4 Financing pain relief within the national system .................................................................56
4.5 Estimatingneedsforpainrelief .........................................................................................57
4.6 Saving resources by treating pain .......................................................................................58
4.7 Pain management coverage ...............................................................................................59
4.8 Human resources for pain management .............................................................................59
4.9 What treatment should be available ...