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Scholar's Report

Travel: Optimising Palliative Care for Children using a Multimodal (opioid-sparing) Approach to Pain Management-Lessons from the USA

2016/50 - Cheryl Norman


This report focuses on key lessons learnt from attending a Paediatric Pain Master-class in Minneapolis USA.  A multimodal (opioid-sparing) approach to paediatric pain is the main message brought back to UK nursing and to paediatric palliative care.  This is not an approach which is taught or promoted in UK paediatric hospice care in my experience and consequently needs sharing in order to optimise the care given to this cohort of patients.

Six main categories to an opioid-sparing approach are discussed in greater detail which can together reduce the dose of opioid which might be required by the child or young person, (CYP) thus reducing potential side effects and reducing the burden of pain which they experience;

  1. Non-Opioids and a discussion about the use of COX-2 inhibitors for patients at risk of bleeding
  2. Opioids (specifically use of Methadone and cross tolerance of opioids)
  3. Integrative therapies; aromatherapy and massage; distraction; mindfulness; biofeedback; hypnosis
  4. Psychology and rehabilitation
  5. Adjuvants such as Gabepentinoids and Tricyclic anti-depressants
  6. Invasive approaches such as nerve blocks

It is the combination of using the multimodal approach which targets pain at different receptors to include six approaches to pain management inclusive of pharmacological and non-pharmacological which needs promoting and delivering to CYP.

The appendices contain further information learnt from the travel scholarship which is of equal importance but due to word count restrictions had to placed in the appendix.  This enabled the focus to be kept on the multimodal opioid sparing approach to pain for the core theme.  However, additional lessons learnt are:

Specific areas of learning and outcomes which will be highlighted and taught to the palliative care team from this travel scholarship:

At beginning of team meetings we have introduced a five-minute mindfulness exercise to get everyone focused, and get our staff familiar with using mindfulness.