Pain control in children and young people with cancer

Article Outline

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Few data exist that provide an evidence base for choosing among drugs and dosages for management of pain in children with cancer. In this issue of The Journal, Hewitt et al report results of a prospective survey of opioid use in palliative care of patients 0-19 years old with cancer in 22 oncology centers in the United Kingdom. A questionnaire was performed monthly for 6 months or until death in 185 individuals. Professionals collected information on drug use and level of pain. Multiple opioid preparations and routes of administration were used, and maximum dosages were highly variable, ranging from oral morphine equivalent of 0.09 to 1500 mg/kg/24 hours. Children with solid tumors outside the central nervous system were more likely than others to receive multiple opioids and higher doses, and still had pain as a major problem.

The data provide a first step in an evidence-based approach to pain management in palliative care. As the authors point out, however, evidence-based management of pain should also be an integral part of curative care for children and young people with cancer. An accompanying editorial by Baker puts the problem of pain control and strategies for management in perspective.