Persistent/ Chronic Pain (Non-Cancer Pain)

ICD-10 code: R52.2

Persistent/chronic pain is pain that lasts longer than the expected time for healing, and does not always have an obvious physical cause. Best practices for the management of chronic pain in children as recommended by the World Health Organization include:

• Use a comprehensive biopsychosocial assessment to inform pain management and planning. Screen for and monitor pain intensity and its impact on the quality of life of the child and family.
• Evaluation of underlying conditions with access to appropriate treatment, in addition to appropriate interventions for the management of pain.
• Assessment by healthcare providers, skilled and experienced in the evaluation, diagnosis and management of chronic pain.
• Adopting an interdisciplinary, multimodal approach tailored to the needs and desires of the child, family and caregivers, and to available resources. This includes psychology/psychiatry, social worker, physiotherapy, and other providers of non-pharmacological pain management strategies, e.g. aromatherapy, acupuncture.
• Goals of care: return to function, attaining good quality of life, minimising absenteeism from school, and engagement with peers.
• There is insufficient evidence to support the use of medicines for the management of chronic pain, unless pain is associated with underlying pathology, e.g. rheumatological disease, nerve injury.

REFERRAL

• In patients with acute pain, adequate analgesia and application of relevant, developmentally appropriate non-medicine strategies will control pain in most cases.
• Patients with resistant chronic pain should be discussed or referred to specialist centres experienced in paediatric chronic pain management.

Click here for the pdf.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024 

Chapter 20: Pain Control, 20.1.1 Management of Pain,  20.1.1.2 Persistent/Chronic Pain (Non-Cancer Pain)