Introduction
Overview
Quality pain management is a fundamental human right. Pain in youth should be managed using a multimodal, biopsychosocial approach employing physical, psychological, and pharmacologic modalities.
In cases of moderate or severe pain, the addition of opioids may be warranted for managing short-term pain or chronic pain. When clinically indicated, adding opioids to non-opioid analgesia should not be withheld.
In Canada, there is a lack of evidence based guidelines driving effective and safe opioid prescribing for quality pain management for children and youth.
“I have friends who need medications for all kinds of illnesses, but I’m the only one who feels the need to lie and keep my pain medications a secret because of all the rude comments that follow. I shouldn’t have to be ashamed of needing opioids as someone with a chronic illness, and it makes me sad that it’s looked down upon when it makes such a difference in my life. Opioids are sometimes the difference between me lying in bed, wishing I could live a normal life - and me living a normal life.”
~ Ariana, Youth Patient Partner
The ongoing opioid crisis has profound impacts on the lives of Canadians, making it crucial to address the appropriate and destigmatized use of opioids in youth while mitigating the broader impact of pain on families, communities, and society.
Undertreatment of pain is a significant contributor to the opioid crisis, and poorly managed pain in youth can lead to a cascade of opioid use that extends into adulthood, emphasizing the urgency to prioritize effective pain management during childhood to prevent potential lifelong harm.
The effective treatment of pain, regardless of cause, starts with a proper pain assessment. Comprehensive pain assessment is foundational for determining the severity of pain, and the potential impact of any pain management approach.
This toolkit summarizes current evidence and resources for safe, effective, and equitable opioid use in managing moderate to severe acute and chronic pain in youth. The information and resources in this toolkit can be integrated into clinical practice, support clinical education, and be used to inform organizational policies. The resources in this toolkit should be helpful for health professionals and the patients and families with whom they work.
This toolkit was guided by the most current and relevant scientific evidence and resources available during its development.
An environmental scan was conducted in April 2023, which included an academic search of systematic and scoping reviews in Ovid Medline. In addition, a grey literature search was conducted by searching the CADTH Grey Matters tool* as well as the Google search engine. Search results were reviewed with patient partners, members of the National Advisory Group for the ‘Youth in Pain’ project, and SKIP Network Hub Leads. The published evidence used to inform this toolkit can be found in the references section.
*Grey matters: A tool for searching health-related grey literature. Ottawa: CADTH; 2023. https://greymatters.cadth.ca. Accessed 2023-04-01
What is Quality Pain Management?
Pain management aims to alleviate or reduce the pain experience using a variety of strategies for prevention, assessment, and treatment of pain. Quality pain management must be:
- Accessible
- Consistent
- Equitable
- Evidence-informed
- Individualized to the unique needs of children and families
- Multimodal
- Safe and Effective
Who created this toolkit?
Solutions for Kids in Pain (SKIP)
SKIP is a knowledge mobilization network funded by the Networks of Centres of Excellence (NCE), based at Dalhousie University, and co-led by Children’s Healthcare Canada.
SKIP seeks to bridge the gap between current treatment practices and available evidence-based solutions for children’s pain in Canadian health institutions. With resources like this toolkit, SKIP’s aim is to improve children’s pain management by mobilizing evidence-based solutions through coordination and collaboration.
SKIP brings together Canada’s world-renowned pediatric pain research community, front-line knowledge user organizations, and patients and caregivers. SKIP capitalizes on the engagement of its 6 hubs (IWK Health Centre, SickKids, Stollery Children’s Hospital, Children’s Healthcare Canada, CHU Sainte-Justine, University of Calgary), over 200 partners, including patients and caregivers to collaborate on knowledge mobilization activities.
Production of this document has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.