go to main contents
Search
Shortcuts
Information for...
Search
URV

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.

Declaration in other languages

La Déclaration de Lima sur la Douleur Dans l'Enfance

  1. La douleur, et particulièrement la douleur chronique, doit être conceptualisée comme une pathologie transversale et non comme un simple symptôme associé à une autre pathologie.
  2. La douleur est une expérience bio-psycho-sociale. Elle est tellement complexe qu'elle doit être prise en charge par une approche interdisciplinaire, et pas seulement médicale.
  3. Les enfants et les adolescents qui souffrent ont le droit de voir leur douleur reconnue et de ne pas être stigmatisés.
  4. Le droit à la prise en charge de la douleur n'est pas négociable. Les enfants et les adolescents ont le droit de recevoir le meilleur traitement possible de la part de professionnels experts. Ne pas faciliter l'accès à la prise en charge de la douleur non seulement aggrave inutilement la souffrance, mais est également discriminatoire et contraire à l'éthique.
  5. Pour que chacun ait accès à une prise en charge appropriée de la douleur, la douleur pédiatrique doit être prise en compte et tous les agents impliqués dans la facilitation du traitement doivent être contraints de prendre toutes les mesures nécessaires pour fournir un traitement et un soulagement.
  6. Compte tenu de la portée juridique de leur pouvoir et de leur autorité, les gouvernements nationaux doivent être responsables de : (1) légiférer et faire des plans pour promouvoir des programmes éducatifs pour les professionnels de la santé qui incluent, entre autres sujets, la prise en charge de la douleur ; (2) permettre aux jeunes qui souffrent d'accéder au meilleur traitement possible ; (3) mener des programmes pour sensibiliser et éduquer les gens sur la douleur pédiatrique et son traitement ; et (4) fournir des ressources pour financer adéquatement la recherche sur la douleur pédiatrique.
  7. Compte tenu de la portée juridique de leur pouvoir et de leur autorité, les établissements de santé doivent être responsables de la mise en place de systèmes permettant aux jeunes en douleur d'accéder au meilleur traitement possible.
  8. Considérant la portée légale de leur pouvoir et de leur autorité, les professionnels de la santé doivent être responsables de l'utilisation des résultats empiriques pour fournir le meilleur traitement.
  9. Compte tenu de la portée légale de leur pouvoir et de leur autorité, les sociétés professionnelles et scientifiques doivent être responsables de veiller à ce que leurs congrès et symposiums aient un contenu lié à la douleur pédiatrique afin que les chercheurs et les cliniciens qui se consacrent à l'étude et au traitement de la douleur pédiatrique puissent se former et actualiser leurs connaissances.
  10. Les enfants et les adolescents en douleur et leurs familles ont une voix. Cette voix est d'une immense valeur et constitue un outil clé pour aller de l'avant. Elle doit être entendue et intégrée dans la rédaction des lois, les programmes de formation, les campagnes de sensibilisation, la promotion de la recherche et la planification des conférences scientifiques. Chaque pas en avant doit être fait avec la collaboration de ceux qui vivent le problème en première personne.

Declaração de Lima sobre a Dor Infantil (POR)

  1. A dor deve ser conceituada como uma patologia transversal e não como um mero sintoma associado a outra patologia, especialmente no caso da dor crónica.
  2. A dor é uma experiência de natureza biopsicossocial e, dada a sua complexidade, requer cuidados interdisciplinares, não apenas médicos.
  3. Crianças e jovens com dor têm o direito de ter a sua dor reconhecida e de não serem estigmatizados por isso.
  4. O tratamento da dor é um direito inalienável. As crianças e os jovens com dor têm o direito de aceder ao melhor tratamento possível realizado por profissionais especializados. Não facilitar o acesso ao tratamento da dor para crianças e adolescentes causa sofrimento adicional desnecessário, além de ser discriminatório e eticamente condenável.
  5. Para que isso seja possível, é necessário que a dor da criança realmente importe e que todos os agentes envolvidos na facilitação do seu tratamento se sintam obrigados a tomar as medidas necessárias para o tornar viável.
  6. Considerando o alcance dos limites legais da sua competência e autoridade, seria obrigação dos governos nacionais: (1) elaborar leis e planos que promovessem programas educacionais voltados para os profissionais de saúde que incluíssem, entre outros aspetos, a gestão da dor; (2) facilitar o acesso dos jovens com dor ao melhor tratamento possível; (3) levar a cabo programas de sensibilização e educação da população sobre a dor na infância e o seu tratamento; e (4) fornecer recursos para financiar adequadamente a pesquisa sobre a dor infantil.
  7. Considerando o alcance dos limites legais da sua competência e autoridade, seria obrigação das instituições de saúde viabilizar os sistemas que promovessem o acesso ao melhor tratamento possível para os jovens com dor.
  8. Considerando as exigências legais e deontológicas da prática profissional e os recursos disponíveis, seria obrigação dos profissionais de saúde administrar o melhor tratamento para a dor com base nos conhecimentos disponíveis.
  9. Considerando o alcance dos limites legais de sua competência e autoridade, seria obrigação das sociedades científicas e profissionais garantir que os seus eventos científicos (congressos e conferências) incluíssem conteúdos específicos sobre a dor infantil para facilitar a formação e atualização de conhecimentos dos investigadores e clínicos dedicados ao estudo e tratamento da dor infantil.
  10. A voz de crianças e adolescentes com dor e a das suas famílias têm um valor extraordinário sendo uma ferramenta fundamental para avançar. As suas posições devem ser ouvidas e integradas na elaboração de leis, programas de formação, campanhas de sensibilização, promoção da investigação e organização de conferências científicas. Nada do que se propõe para avançar deve ser feito "às escondidas" ou sem a colaboração de quem vivencia o problema em primeira pessoa.

Declaração de Lima sobre a Dor Infantil (BRA)

  1. A dor deve ser conceituada como uma patologia transversal e não como um mero sintoma associado a outra patologia, especialmente no caso da dor crônica.
  2. A dor é uma experiência de natureza biopsicossocial e, por sua complexidade, requer cuidados interdisciplinares, não apenas médicos.
  3. Crianças e jovens com dor têm o direito de ter sua dor reconhecida e não serem estigmatizados por isso.
  4. O tratamento da dor é um direito inalienável. As crianças e os jovens com dor têm o direito de aceder ao melhor tratamento possível realizado por profissionais especializados. Não facilitar o acesso ao tratamento da dor para crianças e adolescentes causa sofrimento adicional desnecessário, além de ser discriminatório e eticamente condenável.
  5. Para que isso seja possível, é necessário que a dor da criança importe e que todos os agentes envolvidos na facilitação de seu tratamento se sintam obrigados a realizar as ações que visem a sua viabilização.
  6. Considerando o alcance dos limites legais de sua competência e autoridade, seria obrigação dos governos nacionais: (1) elaborar leis e planos que promovam programas educacionais voltados aos profissionais de saúde que incluam, entre outros aspectos, o manejo da dor; (2) facilitar o acesso dos jovens com dor ao melhor tratamento possível; (3) realizar programas de conscientização e educação da população sobre a dor na infância e seu tratamento; e (4) fornecer recursos para financiar adequadamente a pesquisa sobre a dor infantil.
  7. Considerando o alcance dos limites legais de sua competência e autoridade, seria obrigação das instituições de saúde viabilizar sistemas que promovam o acesso ao melhor tratamento possível para os jovens com dor.
  8. Considerando as exigências legais e deontológicas da prática profissional e os recursos disponíveis, seria obrigação dos profissionais de saúde administrar o melhor tratamento com base nos conhecimentos disponíveis.
  9. Considerando o alcance dos limites legais de sua competência e autoridade, seria obrigação das sociedades científicas e profissionais garantir que seus congressos e conferências incluam conteúdos específicos sobre dor infantil para facilitar a formação e atualização de conhecimentos de pesquisadores e clínicos dedicados ao estudo e tratamento da dor infantil.
  10. A voz de crianças e adolescentes com dor e suas famílias tem um valor extraordinário, é uma ferramenta fundamental para seguir em frente. Suas posições devem ser ouvidas e incorporadas na elaboração de leis, programas de treinamento, campanhas de conscientização, promoção de pesquisas e planejamento de conferências científicas. Nada do que se propõe para avançar deve ser feito às escondidas ou sem a colaboração de quem vivencia o problema em primeira pessoa.

إعلان ليما عن الألم لدى الأطفال

يجب إعتبار الألم ، وخاصة الألم المزمن ، على أنه مرض مستعرض وليس مجرد عارض مرتبط بمرض آخر. ١

الألم هو تجربة بيولوجية-نفسية-اجتماعية. وهو معقد لدرجة أن معالجته تحتاج نهج متعدد التخصصات ، وليس فقط من النهج الطبي. ٢

للأطفال والمراهقين الذين يعانون من الألم الحق في أن يُعترف بألمهم وعدم وصمهم. ٣

الحق في معالجة الألم غير قابل للتفاوض. للأطفال والمراهقين الحق في الحصول على أفضل علاج متاح من المتخصصين الخبراء. عدم تسهيل الوصول إلى إدارة الألم لا يؤدي فقط إلى تفاقم المعاناة دون داع ، بل إنه تمييزي أيضًا وغير أخلاقي. ٤

للتأكد من أن كل شخص لديه إمكانية الوصول إلى معالجة الألم المناسبة ، يجب أن يكون ألم الأطفال ذو أهمية ويجب على جميع الأطراف المعنية في تسهيل العلاج إتخاذ جميع الإجراءات اللازمة لتوفير العلاج و تخفيف الألم.. ٥

نظراً للنطاق القانوني لسلطاتها، يجب أن تكون الحكومات الوطنية مسؤولة عن: (1) التشريع ووضع الخطط لتعزيز البرامج التعليمية للمهنيين الصحيين التي تشمل ، من بين مواضيع أخرى ، إدارة الألم ؛ (2) تمكين الشباب الذين يعانون من الألم من الحصول على أفضل علاج ممكن ؛ (3) تنفيذ برامج لتوعية الناس وتثقيفهم حول آلام الأطفال وعلاجها ؛ و (4) توفير الموارد اللازمة لتمويل الأبحاث بشكل كافٍ حول آلام الأطفال. ٦

نظراً للنطاق القانوني لسلطاتها ، يجب أن تكون المؤسسات الصحية مسؤولة عن إنشاء أنظمة لمنح الأطفال و المراهقين الذين يعانون من الألم إمكانية الوصول إلى أفضل علاج ممكن. ٧

نظراً للنطاق القانوني لسلطاتها ، يجب أن يكون المتخصصون في الرعاية الصحية مسؤولين عن استخدام النتائج التجريبية لتقديم أفضل علاج ٨

نظراً للنطاق القانوني لسلطاتها ، يجب أن تكون الجمعيات المهنية والعلمية مسؤولة عن ضمان إحتواء مؤتمراتها وندواتها على محتوى متعلق بألم الأطفال حتى يتمكن الباحثون والأطباء المتخصصون في دراسة وعلاج ألم الأطفال من المشاركة في التدريب واتحديث معرفتهم. ٩

الأطفال والمراهقون الذين يعانون من الألم وعائلاتهم لديهم صوت. هذا الصوت له قيمة هائلة ، وهو أداة رئيسية للمضي قدمًا. يجب الاستماع إليه وإدماجه في صياغة القوانين ، وبرامج التدريب ، وحملات التوعية ، وتعزيز البحوث ، والتخطيط للمؤتمرات العلمية. يجب اتخاذ كل خطوة للأمام بالتعاون مع أولئك الذين يواجهون المشكلة من منظور الشخص الأول ١٠.