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[Evaluation of analgesics in children. Round table no. 5. XV]
1Pharmacologie Pédiatrique et Pharmacogénétique, Hôpital Robert Debré, Paris, France.
Insights
Childhood pain in France is undertreated due to inconsistent evaluation and insufficient analgesic use. Improving pain management requires better assessment tools and more approved pediatric medications.
Area of Science:
- Pediatric Pain Management
- Neuroscience of Pain
- Clinical Pharmacology
Context:
- Childhood pain in France is frequently underevaluated and undertreated, with significant heterogeneity in clinical practice.
- Pain assessment in pediatric populations presents challenges due to developmental variations in nociceptive pathways.
- Parental and psychosocial factors significantly influence a child's pain experience.
Purpose:
- To highlight the critical issues in pediatric pain management in France.
- To emphasize the need for improved pain assessment strategies and validated hetero-evaluation scores for younger children.
- To advocate for the development and approval of more analgesics for pediatric use, particularly for neonates.
Summary:
- Current pediatric pain management in France suffers from under-evaluation and undertreatment, compounded by a lack of validated assessment tools for children under six and insufficient availability of licensed analgesics.
- The 'Pediadol' survey indicated inadequate analgesic use in children, with many adult-approved drugs lacking pediatric licensing due to formulation issues, especially critical for infants.
- Addressing these gaps requires generalized pain evaluation, validation of hetero-evaluation scores, rigorous assessment of analgesics for pediatric approval, and enhanced training for healthcare providers.
Impact:
- Standardizing pain evaluation methods across all age groups in children.
- Increasing the availability of safe and effective analgesics specifically formulated and approved for pediatric use.
- Elevating healthcare provider awareness and competence in managing pediatric pain effectively.
Abstract:
Despite recent progress, childhood pain in France is still underevaluated and undertreated and its treatment very heterogeneous among clinicians and health care providers. Pain assessment is often a difficult task in this population. The ontogeny of nociceptive pathways, their maturation, and their functionality during development are not completely understood. Painful sensations primarily involve the child's own experience but can be modified, influenced by his/her parents and the psychosocial environment with their own experience of pain and anxiety. The use of analgesics cannot be precisely quantified using retail sales data. However, the 'Pediadol' survey has demonstrated that their use in children experiencing painful situations is definitely insufficient. Also, another survey conducted among pharmacists showed that at least one-third of analgesics approved for adults are not licensed for paediatric use, sometimes due to inadequate drug formulation. The situation is even more critical for young infants and neonates for whom there are even fewer available approved analgesics. A number of issues need to be addressed in order to improve pain management in children. First of all, evaluation of pain should be generalized. Auto-evaluation should be used in children over 6 years of age. Under 6 years, the initial step would be to further evaluate and validate hetero-evaluation scores. Second, analgesics should be evaluated in order to be licensed for paediatric use. When possible, data obtained in adults or older children should be used and studies in younger infants performed only when necessary. Finally it is of paramount importance to continue to increase paediatricians' and health care providers' awareness of the existence of pain in children and to train them to evaluate pain and treat it appropriately.