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Management of pain in leukemic children using the WHO analgesic ladder
M G Geeta1, P Geetha, V T Ajithkumar
1Department of Pediatrics, Institute of Maternal and Child Health, Medical College, Calicut, Kerala, India, geetakkumar@gmail.com.
Insights
The World Health Organization (WHO) analgesic ladder effectively manages pain in pediatric leukemia patients. Most cases are controlled with non-opioids and weak opioids, but severe pain may need specialist intervention.
Area of Science:
- Pediatric Oncology
- Pain Management
- Palliative Care
Background:
- Leukemia is a common childhood cancer.
- Effective pain management is crucial for improving quality of life in children with leukemia.
- The World Health Organization (WHO) analgesic ladder provides a framework for pain control.
Purpose of the Study:
- To evaluate the effectiveness of the WHO analgesic ladder for pain management in children with leukemia.
- To identify the types of pain and analgesia steps required for pediatric leukemia patients.
Main Methods:
- A 6-month study included children with leukemia referred to a pain and palliative care clinic.
- Data collected on patient demographics, leukemia type, pain type, and analgesia step used.
- Effectiveness of each step of the WHO analgesic ladder was assessed.
Main Results:
- 39 children with leukemia (64% of those referred) required pain management.
- 92% had Acute Lymphocytic Leukemia (ALL), 8% Acute Non Lymphocytic Leukemia (ANLL).
- 95% experienced nociceptive pain; 5% neuropathic pain.
- Step 1: 31% effective, Step 2: 54% effective, Step 3: 15% effective.
- Step 3 analgesia was necessary for neuropathic and bone pain.
Conclusions:
- The WHO analgesic ladder is effective for managing pain in pediatric leukemia.
- Most childhood cancer pain can be managed by treating physicians using WHO guidelines.
- Children with severe bone or neuropathic pain may need specialist referral and strong opioids.
- The study highlights the need for specialized pain management services in pediatric cancer centers.
Objective:
To ascertain the effectiveness of WHO analgesic ladder in pain management in children with leukemia.
Methods:
Children with leukemia who were referred to a pain and palliative care clinic attached to the Department of Pediatrics of a medical teaching hospital during a period of 6 months were included in the study.
Results:
Thirty nine (39) children, who constituted 64% of children on treatment for leukemia, required referral to pain and palliative care services during the study period. Of these 92% had Acute Lymphocytic Leukemia (ALL) and 8% had Acute Non Lymphocytic Leukemia (ANLL). 95% of children had nociceptive pain and 5% had neuropathic pain. Step - 1 analgesia was effective in 12 (31%) children and 21 (54%) could be managed with Step - 2 analgesia. Step - 3 analgesia was required in only 6 (15%) children. Step 3 analgesia was required in children with neuropathic pain and bone pain.
Conclusion:
WHO analgesic ladder is effective in managing pain in children with leukemia. Majority of cases of cancer pain in children could be managed by the treating physician using non-opioids, weak opioids and adjuvants as per the WHO guidelines. Children with bone pain and neuropathic pain may require referral to specialist services and use of strong opioids like morphine. The study emphasizes the need for establishing specialist pain management services in all centres where children with cancer are treated.
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