Development of the World Health Organization Guidelines on Cancer Pain Relief and Palliative Care in Children
Child; Practice Guidelines; Human; Neoplasms/complications; Pain/etiology/therapy; Palliative Care/methods; World Health Organization
Assess pain regularly throughout the course of treatment. Follow the WHO Analgesic Ladder for selecting pain-relief drugs, that is, a stepwise approach to analgesic management, where a child's pain severity determines the level of analgesics. Use practical cognitive, behavioral, physical, and supportive therapies, combined with appropriate drug treatment. Administer adequate analgesics doses "by the clock," that is, at regular times, not PRN. Use oral routes for administering analgesics, and avoid painful routes of administration, whenever possible. Administer a sufficient analgesic dose to allow children to sleep throughout the night. Anticipate and treat side effects aggressively.
1996
McGrath PA
Journal Of Pain And Symptom Management
1996
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Symptoms and Suffering at the End of Life in Children with Cancer
Child; Humans; Terminal Care; Health Care Surveys; Parents; Withholding Treatment; Logistic Models; Questionnaires; Physicians; Boston; Longitudinal Studies; Quality of Health Care; quality of life; Empirical Approach; Non-U.S. Gov't; P.H.S.; Professional Patient Relationship; Research Support; U.S. Gov't; Death and Euthanasia; Psychological; Stress; Clodronate; Neoplasms/complications/therapy; Oncology at EOL; Pain/etiology/therapy; Anorexia/etiology/therapy; home care services; Children's Hospital (Boston); Constipation/etiology/therapy; Dana-Farber Cancer Institute (Boston); Diarrhea/etiology/therapy; Dyspnea/etiology/therapy; Fatigue/etiology/therapy; Palliative Care/standards/statistics & numerical data
Cancer is the leading cause of nonaccidental death in childhood.1 There has, however, been little evaluation of the overall experience at the end of life of children who are dying of cancer or of their symptoms other than pain.2,3 A number of studies have demonstrated that among adults, the quality of care at the end of life is suboptimal.4–8 For example, one study of elderly patients found that there was considerable suffering at the end of life, with up to 25 percent of patients experiencing moderate-to-severe pain in the last three days of life.7 It is not known . . .
2000-02
Wolfe J; Grier Holcombe E; Klar Neil; Levin SB; Ellenbogen JM; Salem-Schatz S; Emanuel EJ; Weeks Jane C
New England Journal Of Medicine
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1056/NEJM200002033420506" target="_blank" rel="noreferrer">10.1056/NEJM200002033420506</a>
Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache
Female; Humans; Male; Adult; Middle Aged; Research Design; Behavior Therapy; Non-U.S. Gov't; Research Support; Chronic disease; Cognitive Therapy; Randomized Controlled Trials; Pain/etiology/therapy; Sample Size
A computer and a hand search of the literature recovered 33 papers from which 25 trials suitable for meta-analysis were identified. We compared the effectiveness of cognitive-behavioural treatments with the waiting list control and alternative treatment control conditions. There was a great diversity of measurements which we grouped into domains representing major facets of pain. Effect sizes, corrected for measurement unreliability, were estimated for each domain. When compared with the waiting list control conditions cognitive-behavioural treatments were associated with significant effect sizes on all domains of measurement (median effect size across domains = 0.5). Comparison with alternative active treatments revealed that cognitive-behavioural treatments produced significantly greater changes for the domains of pain experience, cognitive coping and appraisal (positive coping measures), and reduced behavioural expression of pain. Differences on the following domains were not significant; mood/affect (depression and other, non-depression, measures), cognitive coping and appraisal (negative, e.g. catastrophization), and social role functioning. We conclude that active psychological treatments based on the principle of cognitive behavioural therapy are effective. We discuss the results with reference to the complexity and quality of the trials.
1999
Morley S; Eccleston C; Williams A
Pain
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0304-3959(98)00255-3" target="_blank" rel="noreferrer">10.1016/s0304-3959(98)00255-3</a>
Treatment of pain in pediatric oncology: a Swedish nationwide survey
Child; Female; infant; Male; Pain Measurement; Education; Questionnaires; Sweden; Combined Modality Therapy; Education; Preschool; Non-U.S. Gov't; infant; Newborn; Human; Nursing; Support; Adolescence; Neoplasms/complications; continuing; Medical; Drug Administration Routes; Physician's Practice Patterns; Antineoplastic Agents/adverse effects; continuing; Hospital Departments; Morphine/adverse effects; Pain/etiology/therapy; Radiotherapy/adverse effects
Pain treatment is a crucial aspect in the care of children with cancer and there are many studies demonstrating inefficient pain treatment. In this study, questionnaires dealing with pain treatment of children with malignant diseases were sent to all (47) pediatric departments in Sweden. The aims of this nationwide survey were to evaluate the extent and causes of pain, the use of methods for pain evaluation (e.g. analysis of type of pain and monitoring of pain intensity), principles of pain management, side effects of pain treatment and the educational needs of physicians and nurses regarding these issues. The response rate was 100%. Answers from physicians and nurses reveal that pain is a common symptom during different periods of cancer treatment. Pain due to treatment and procedures is a greater problem than pain due to the malignant disease itself. Instruments for the measurement of pain intensity and analysis of the type of pain are still rarely used. Most physicians (63%) follow the analgesic 'ladder' principle recommended by World Health Organization (WHO). According to a majority of physicians and nurses (72%), pain could be treated more effectively than it is presently, and 64% state that they need more time for the management of pain. Both physicians and nurses state that they need additional education in different areas of pain evaluation and pain treatment. Swedish treatment practices for the management of pediatric cancer pain roughly follow the published guidelines, but many improvements are still necessary.
1996
Ljungman G; Kreuger A; Gordh T; Berg T; Sorensen S; Rawal N
Pain
1996
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0304-3959(96)03193-4" target="_blank" rel="noreferrer">10.1016/s0304-3959(96)03193-4</a>
Control of inflammatory pain by chemokine-mediated recruitment of opioid-containing polymorphonuclear cells
Male; Pain Measurement; Analysis of Variance; Animals; Rats; Non-U.S. Gov't; Research Support; Comparative Study; Dose-Response Relationship; Drug; Receptors; Naloxone/pharmacology; Freund's Adjuvant; Wistar; Flow Cytometry/methods; Antibodies/pharmacology; Cell Count/methods; Cell Movement/physiology; Chemokines; Chemokines/immunology/physiology; Corticotropin-Releasing Hormone/therapeutic use; CXC/immunology/metabolism; Drug Administration Routes; Enzyme-Linked Immunosorbent Assay/methods; Gene Expression Regulation/physiology; Immunohistochemistry/methods; Intercellular Signaling Peptides and Proteins/immunology/metabolism; Interleukin-8B/metabolism; Narcotics/metabolism; Neurogenic Inflammation/chemically induced/complications/therapy; Neutrophils/metabolism; Pain Threshold/drug effects; Pain/etiology/therapy
Opioid-containing leukocytes can counteract inflammatory hyperalgesia. Under stress or after local injection of corticotropin releasing factor (CRF), opioid peptides are released from leukocytes, bind to opioid receptors on peripheral sensory neurons and mediate antinociception. Since polymorphonuclear cells (PMN) are the predominant opioid-containing leukocyte subpopulation in early inflammation, we hypothesized that PMN and their recruitment by chemokines are important for peripheral opioid-mediated antinociception at this stage. Rats were intraplantarly injected with complete Freund's adjuvant (CFA). Using flow cytometry, immunohistochemistry, and ELISA, leukocyte subpopulations, chemokine receptor (CXCR2) expression on opioid-containing leukocytes and the CXCR2 ligands keratinocyte-derived chemokine (KC), macrophage inflammatory protein-2 (MIP-2) and cytokine-induced neutrophil chemoattractant-2 (CINC-2) were quantified. Paw pressure threshold (PPT) was determined before and after intraplantar and subcutaneous injection of CRF with or without naloxone. PMN depletion was achieved by intravenous injection of an antiserum. Chemokines were blocked by intraplantar injection of anti-MIP-2 and/or anti-KC antiserum. We found that at 2 h post CFA (i) intraplantar but not subcutaneous injection of CRF produced dose-dependent and naloxone-reversible antinociception (P0.05, ANOVA). In summary, in early inflammation peripheral opioid-mediated antinociception is critically dependent on PMN and their recruitment by CXCR2 chemokines.
2004
Brack A; Rittner HL; Machelska H; Leder K; Mousa SA; Schafer M; Stein C
Pain
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.pain.2004.08.029" target="_blank" rel="noreferrer">10.1016/j.pain.2004.08.029</a>