The Lancet Child & Adolescent Health Commission

Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission

Executive summary

Every infant, child, and adolescent will experience pain at times throughout their life. Childhood pain ranges from acute to chronic, and includes procedural, disease-related, breakthrough, and other types of pain. Despite its ubiquity, pain is a major challenge for individuals, families, health-care professionals, and societies. As a private mental experience, pain is often hidden and can go undiscussed or ignored. Undertreated, unrecognised, or poorly managed pain in childhood leads to

Goal 1: make pain matter

When one is in severe pain, nothing is as important as finding relief. But pain in others evokes a less urgent response. Pain is often expected to be transitory, diagnostically useful, bearable, and easily forgotten, but when this is not the case it is more difficult to tolerate. Although people can often be highly sensitive to their own pain, a social insensitivity to pain in others is common,11, 12 and when people describe their pain the importance of it can be too easily diminished.¹³ In

Goal 2: make pain understood

Improvements in the care of children with pain—including better recognition, valid explanation, reliable assessment, and the development of safe and effective treatments—will only emerge in a safe and sustainable way if they are informed by a full scientific understanding of pain. Our second goal is to make childhood pain understood by improving our fundamental knowledge of the developmental aspects of nociception and pain systems.

Goal 3: make pain visible

Childhood pain can be assessed, no matter the age or clinical status of the child. Children need the opportunity to communicate their pain to clinicians, parents, and caregivers to drive decision making regarding treatment options and to evaluate whether a treatment is efficacious. Nevertheless, there are challenges, especially in the youngest patients, and in patients with intellectual, communication, or motor limitations. However, assessment methods are available and should be used. Pain

Goal 4: make pain better

Every child should have access to evidence-based pain assessment and subsequent treatment using the most effective methods and means available. A growing number of high-quality systematic reviews, meta-analyses, and clinical practice guidelines show that some psychological, pharmacological, physical, and integrative treatment modalities are efficacious in reducing pain and improving function.32, 291, 292, 293, 294, 295 These treatment strategies are crucial for care to move beyond historical

Transformative action for policy makers and funders

Child pain matters. But not, it seems, to everyone—not for every child, and not for every pain. The pain community has to work harder to make child pain matter to all, understood, and visible, and to make it important enough to bring out into the open and to be acted upon. Only then can pain be made better. However, these goals are not sequential, and each must be addressed simultaneously to improve the wellbeing of infants, children, adolescents, and the adults they become.

The

Conclusion

This Commission has covered four important goals that we believe will advance the field of paediatric pain over the next 10 years. We have set out goals and priorities to improve research and practice, but it will take the entire research and clinical community, in collaboration with funders and policy makers, to achieve these goals. It was not possible to cover everything in this Commission. We have focused on high-income and middle-income countries but recognise that there are different