Strong opioids in pediatric palliative medicine.

The management of pain in the palliative care of children is somewhat different from that in adults. It also differs in approach from the management of other types of acute and chronic pain in childhood. Whereas once opioids were thought to be highly dangerous drugs, unsuitable for use in children, they have now taken their place as the mainstay for provision of good analgesia to manage moderate-to-severe pain in both malignant and non-malignant life-limiting conditions. There are relatively little clinical or laboratory data regarding opioids specifically in children. However, much of what has been published regarding the management of pain in palliative medicine in adults can be extrapolated. On saying that, early research in children does suggest some significant differences in opioid pharmacokinetics, particularly with respect to morphine clearance, which seems to be faster in adults. Thus, the use of opioids in pediatric palliative care presents some unique challenges. Confident and rational use of opioids by pediatricians, illustrated by the WHO guidelines, is essential for the adequate management of pain complicating the palliative phase in children with life-limiting conditions.