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SCOPING DOCUMENT for WHO Treatment Guidelines on Pain Related To

SCOPING DOCUMENT for WHO Treatment Guidelines on Pain Related To

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 Scoping Document for WHO Treatment Guideline on Pain Related to Cancer, HIV andother progressive life-threatening illnesses in adultsAdopted in WHO Steering Group on Pain Guidelines, 14 October 2008
1
SCOPING DOCUMENT FORWHO Treatment Guidelines on pain related to cancer, HIV and otherprogressive life-threatening illnesses in adults
BACKGROUND
The justification for developing these guidelines lies in the need to update existingguidelines for cancer pain management. Published in 1996 (1), some aspects are now outof date as new drugs have come on the market whilst others have dropped out of commonclinical practice. The Delphi study conducted in June 2007 (2) confirms that experts andprofessional bodies related to pain are looking to the World Health Organization (WHO)to take a lead in this development.Whilst recognising that pain control is only a component of the much wider scope of palliative care in people with cancer, HIV and other progressive life-threatening illnesses,these guidelines could serve as a guide to health care professionals, policy makers andregulatory authorities for facilitating legal access and ensuring proper use of analgesicsand other modalities to achieve rapid, effective and safe pain control. The guidelines willbe jointly developed by the
 Access to Controlled Medicines Programme,
the
Cancer Control Programme, Management of Mental and Brain Disorders, Clinical Procedures
and
Child and Adolescent Health and Development.
 This scoping document sets out:
 
the overall objective of these guidelines
 
the types of patients to whom the guidelines apply
 
the outcomes that are sought
 
the proposed table of contents for the publication, and
 
the clinical questions for which evidence needs to be sought and appraised so thatevidence-based recommendations can be made.The full guidelines should be developed in accordance with the principles for clinicalguidelines laid down by the WHO Guideline Review committee.
 OBJECTIVES AND PATIENT POPULATION
The overall objective of these guidelines is to provide evidence-based recommendationsthat, if followed, will improve the pain experience of adult patients with chronic painrelated to cancer, HIV/AIDS, progressive life-threatening illnesses and organ failure.These conditions were identified because they cause significant global burden now andare set to rise (see table 1).
 
 Scoping Document for WHO Treatment Guideline on Pain Related to Cancer, HIV andother progressive life-threatening illnesses in adultsAdopted in WHO Steering Group on Pain Guidelines, 14 October 2008
2Some therapies which contribute to the improvement of the pain experience are beyondthe scope of this document. These include disease-modifying therapies (e.g. anti-cancertherapies, anti-retroviral therapies), These would be addressed by other WHO guidelinesand reference /linkages will be made to them as needed.Patient population: These guidelines address adults and adolescents (i.e. people aged 11-18 years) with chronic pain related to malignant conditions (cancer), HIV/AIDS, andother progressive diseases. Since pharmacology for adolescents is similar to adult,management of pain related to cancer, HIV, and other life threatening illnesses inadolescents is included in this guideline.The critical outcomes that should be considered include: effectiveness of pain relief, andmaintenance of pain reduction, cost effectiveness,speed at which pain reduction may beachieved, maintenance of pain relief, effect on quality of life, effect on an individual’sfunction, anxiety and mood,adverse effects ,complications of treatments/interventionsand risk-benefit analysis of interventions for pain relief.
Table 1 Disability-adjusted Life Years (DALYs) in 2002 and projections to 2030
Source: Matthers & Loncar 2006 
(3)
 
Total DALYs (‘000)Diseases2002 2030 (baseline projection)
Malignant neoplasms 75,336 105,001HIV/AIDS 82,380 185,923Cardiovascular 148,985 176,999Chronic obstructive pulmonary disease 28,049 48,369Diabetes 16,165 29,715Alzheimer and other dementias 10,392 18,394
PROPOSED TABLE OF CONTENTS
A. Executive summaryThe objective of these guidelines, the patients to whom they apply, the target audienceand key recommendations should be stated.Acknowledgment would be included before the executive summary.
 
 Scoping Document for WHO Treatment Guideline on Pain Related to Cancer, HIV andother progressive life-threatening illnesses in adultsAdopted in WHO Steering Group on Pain Guidelines, 14 October 2008
3B. IntroductionThis should include:
 
a clear statement on the overall objective of these guidelines and the patients to whomthese guidelines are meant to apply
 
a statement on target audience: who will use these guidelines - physicians, nurses,physician assistant, clinicians, specialists, general practitioners, pharmacists, caringfor adults. It also aims at policy makers and programme managers, who may not beinvolved directly in providing care, nevertheless play an important role in ensuringcare of patients
 
a clear statement on what is beyond the scope of this document
 
a description of the biopsychosocial context in which these guidelines arecontained - in particular the wider context of palliative care, the importance of holisticcare of patients and their families and the recognition of pain as only one of manysymptoms and areas of concern for patients with these diseases (with reference toother key documents relating to palliative care: ref 4, 5 and 6)
 
the concept of total pain based on IASP and WHO definitions including thepsychological, emotional, cultural and social sequelae of living with chronic painover prolonged periods of time
 
the recognition that much of pain management can be carried out in primary care andthe community, with only a relatively small percentage of patients requiring specialistpain management
 
the effectiveness of a coordinated team approach, in its broadest sense, i.e. dependingon the resources available and the setting in which pain is being managed, teams mayvary in composition (different disciplines, professions and combinations of professionals and non-professionals), complexity and size.C. Causes and classification of painThis should be a brief section (maximum one page) to state:
 
a definition and diagnostic features of the following:
o
 
nociceptive pain – including somatic, visceral, musculoskeletal pain
o
 
neuropathic pain
o
 
breakthrough or episodic pain
o
 
malignant vs non-malignant pain
o
 
acute vs chronic pain
o
 
pain at rest and pain on movement
o
 
mixed pain (nociceptive and neuropathic components together)
 
the key investigations/actors which can be helpful in distinguishing between differentcauses/types of pain

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