Declaration of Lima on Pain in Childhood - 24 August 2022

Caring for children and adolescents in pain and their families is an inexcusable duty

Context

Pain is a common experience in children and adolescents. As far as acute pain is concerned, research has shown that newborns are subjected to numerous painful procedures in neonatal intensive care units (Cruz, Fernandes, & Oliveira, 2016). Available evidence has also shown that the prevalence of moderate-to-severe pain is high while they are in hospital (Groenewald, Rabbitts, Schroeder, & Harrison, 2012). Similarly, research on chronic pain shows that prevalence is not only high (Huguet & Miró, 2008) but also increasing (Roy et al., 2022), including the prevalence of the most severe cases (Miró et al., 2022). In fact, the World Health Organization regards chronic pain itself as a disease (World Health Organization, 2020).

Essentially, pain in children is a public health problem (Miró, 2010). Available data reveal that pain can have a severe effect on the life of children and adolescents and can become chronic. Patients with chronic pain can undergo significant physical, cognitive and emotional problems (Haraldstad, Sørum, Eide, Natvig, & Helseth, 2011; Luntamo, Sourander, Santalahti, Aromaa, & Helenius, 2012; Maes et al., 2017). Pain is a burden not only for the children who are afflicted, but also for all those around them (Tumin et al., 2018). So it becomes not only an individual health problem, but also a social and economic one (Groenewald, Essner, Wright, Fesinmeyer, & Palermo, 2014).

In spite of all the above, pain in children and adolescents is still unrecognized, understudied and untreated (Miró, 2010).

The Declaration of Lima on Pain in Childhood is based on and indebted to the Declaration of Montreal, a document that emerged out of the International Summit on Pain organized by the International Association for the Study of Pain, IASP, in 2010. At that time, delegates proclaimed that most countries managed pain inadequately and declared that access to pain treatment is a human right.

Preface

The Declaration of Lima on Pain in Childhood was also inspired by the work done by the Ibero-American Network for the Study of Child and Adolescent Chronic Pain, and aims to respond to the demands of all those interested in studying and treating pediatric pain. It aspires to facilitate and promote a collaborative space in which patients, associations, researchers, clinicians, members of the industry and legislators recognize needs and demands, and help to improve the recognition and treatment of pediatric pain in the Ibero-American region, and the world.

The motto underlying the Declaration of Lima is "Caring for children and adolescents in pain and their families is an inexcusable duty."

Hence, in the framework of the 14th Latin American Congress on Pain (FEDELAT), the 18th Ibero-American Meeting on Pain and the 19th Peruvian Congress on Pain, we have drawn up the following decalogue under the title of the Declaration of Lima on Pain i Childhood:

1. Pain, and particularly chronic pain, must be conceptualized as a transversal pathology and not as a mere symptom associated with another pathology.
2. Pain is a bio-psycho-social experience. It is of such complexity that it should be managed by an interdisciplinary, not just a medical, approach.
3. Children and adolescents in pain have the right to have their pain acknowledged and not be stigmatized.
4. The right to pain management is non-negotiable. Children and adolescents have the right to receive the best treatment available from expert professionals. Not facilitating access to pain management not only aggravates suffering unnecessarily, it also discriminates and is unethical.
5. To ensure that everyone has access to appropriate pain management, pediatric pain should matter and all agents involved in facilitating treatment should be compelled to take all necessary actions to provide treatment and relief.
6. Considering the legal scope of their power and authority, national governments must be responsible for: (1) legislating and making plans to promote educational programs for health professionals that include, among other subjects, pain management; (2) enabling young people in pain to access the best possible treatment; (3) running programs to raise awareness and educate people about pediatric pain and its treatment; and (4) providing resources to adequately fund research on pediatric pain.
7. Considering the legal scope of their power and authority, health institutions must be responsible for setting up systems to give young people in pain access to the best possible treatment.
8. Considering the legal scope of their power and authority, healthcare professionals must be responsible for using empirical findings to provide the best treatment.
9. Considering the legal scope of their power and authority, professional and scientific societies must be responsible for ensuring that their congresses and symposiums have pediatric pain-related content so that researchers and clinicians dedicated to the study and treatment of pediatric pain can engage in training and update their knowledge.
10. Children and adolescents in pain and their families have a voice. This voice is of immense value, and is a key tool for moving forward. It should be heard and incorporated into the drafting of laws, training programs, awareness campaigns, research promotion and the planning of scientific conferences. Every step forward should be taken with the collaboration of those who experience the problem in the first person.

References

Cruz, M. D., Fernandes, A. M., & Oliveira, C. R. (2016). Epidemiology of painful procedures performed in neonates: A systematic review of observational studies. European Journal of Pain, 20(4), 489-498. http://doi.org/10.1002/ejp.757

Groenewald, C. B., Essner, B. S., Wright, D., Fesinmeyer, M. D., & Palermo, T. M. (2014). The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States. The Journal of Pain, 15(9), 925-933. http://doi.org/10.1016/j.jpain.2014.06.002

Groenewald, C. B., Rabbitts, J. A., Schroeder, D. R., & Harrison, T. E. (2012). Prevalence of moderate-severe pain in hospitalized children. Paediatric Anaesthesia, 22(7), 661-668. http://doi.org/10.1111/j.1460-9592.2012.03807.x

Haraldstad, K., Sørum, R., Eide, H., Natvig, G. K., & Helseth, S. (2011). Pain in children and adolescents: prevalence, impact on daily life, and parents' perception, a school survey. Scandinavian Journal of Caring Sciences, 25(1), 27-36. http://doi.org/10.1111/j.1471-6712.2010.00785.x

Huguet, A., & Miró, J. (2008). The Severity of Chronic Pediatric Pain: An Epidemiological Study. Journal of Pain, 9(3). http://doi.org/10.1016/j.jpain.2007.10.015

Luntamo, T., Sourander, A., Santalahti, P., Aromaa, M., & Helenius, H. (2012). Prevalence changes of pain, sleep problems and fatigue among 8-year-old children: years 1989, 1999, and 2005. Journal of Pediatric Psychology, 37(3), 307-318. J http://doi.org/10.1093/jpepsy/jsr091

Maes, M., Van den Noortgate, W., Fustolo-Gunnink, S. F., Rassart, J., Luyckx, K., & Goossens, L. (2017). Loneliness in Children and Adolescents With Chronic Physical Conditions: A Meta-Analysis. Journal of Pediatric Psychology, 42(6), 622-635. http://doi.org/10.1093/jpepsy/jsx046

Miró, J. (2010). Dolor crónico: ¿un problema de salud pública también entre los más jóvenes? Rev. Soc. Esp. Dolor, 17(7), 301-303.

Roy, R., Galán, S., Sánchez-Rodríguez, E., Racine, M., Solé, E., Jensen, M. P., & Miró, J. (2022). Cross-National Trends of Chronic Back Pain in Adolescents: Results From the HBSC Study, 2001-2014. The Journal of Pain, 23(1), 123-130. http://doi.org/10.1016/j.jpain.2021.07.002

Tumin, D., Drees, D., Miller, R., Wrona, S., Hayes, D. J., Tobias, J. D., & Bhalla, T. (2018). Health Care Utilization and Costs Associated With Pediatric Chronic Pain. The Journal of Pain, 19(9), 973-982. http://doi.org/10.1016/j.jpain.2018.03.012

World Health Organization. (2020). Guidelines on the management of chronic pain in children. Geneve: World Health Organization.