Control of severe pain in children with terminal malignancy☆,☆☆,★,★★
Section snippets
METHODS
The study protocol was approved by the clinical investigation committee at the Dana-Farber Cancer Institute and Children's Hospital, Boston. A retrospective chart analysis was made of the inpatient and outpatient records of the Dana-Farber Cancer Institute and Children's Hospital, Boston, and the hospice agency records (if appropriate) of the 199 patients who died of malignancy after treatment at Children's Hospital, Boston, from March 1989 to July 1993. During this time the WHO algorithm2 was
Patient characteristics
The 199 patients ranged in age at the time of death from 5 months to 20 1/2 years. Forty-four percent had leukemia-lymphoma, 33% solid tumors, and 23% central nervous system tumors. Of the 199 patients, 12 (6%: 7 female, 5 male) required massive opioid infusion. An additional six patients, not described here, received relatively low-dose opioid infusions (<3 mg/kg per hour of intravenous morphine dose equivalent) but required epidural or spinal infusions, or celiac plexus blockade, primarily
DISCUSSION
The WHO recommendations for the management of cancer pain are effective for the majority of children. We have identified a small group of children requiring massive opioid dosing with or without extraordinary measures to achieve adequate analgesia during the terminal phase of their illness. Solid tumors were overrepresented in the group requiring massive opioid infusions, and the most significant predictor of massive opioid need was tumor spread involving spinal nerve roots, major plexus, or
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Cited by (136)
Chronic cancer pain syndromes and their treatment
2022, Neurological Complications of Systemic Cancer and Antineoplastic TherapyThe use of rapid onset fentanyl in children and young people for breakthrough cancer pain
2017, Scandinavian Journal of PainCitation Excerpt :The children given these preparations predominantly had solid tumours. There is evidence that children with solid tumours are more likely than those with other types of cancer to require large doses of opioids to control their pain [21]. It is likely that in our cohort children were prescribed rapid onset fentanyl preparations in an attempt to control pain that was difficult to control with the usual background and breakthrough oral opioids available.
Palliative care and pediatric surgical oncology
2016, Seminars in Pediatric SurgeryUse of opioids in palliative care of children with advanced cancer
2016, Revista Chilena de PediatriaPain Management
2016, Smith's Anesthesia for Infants and Children, Ninth Edition
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From the Pain Treatment Service, Division of Hematology/Oncology, and Departments of Anesthesia, Medicine, and Pathology, Children's Hospital, Boston; the Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston; and the Departments of Anesthesia, Pediatrics, and Pathology, Harvard Medical School, Boston, Massachusetts
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Supported by grants from the Department of Oncology, Children's Hospital, Sydney, New South Wales, Australia, and the Department of Anesthesia, Children's Hospital, Boston, Massachusetts (Dr. Collins), and by the Anesthesia Patient Safety Foundation, Christopher Coakley Memorial Fund, and Mayday Fund (Dr. Berde).
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Reprint requests: Charles B. Berde MD, PhD, Director, Pain Treatment Service, Farley 306, Children's Hospital, 300 Longwood Ave., Boston, MA 02115.
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0022-3476/95/$3.00 + 0 9/25/61755