Pain management in 100 episodes of severe mucositis in children
Michelle C White1, Clare Hommers, Sarah Parry
1Bristol Royal Hospital for Children, Bristol, UK. mcwdoc@doctors.org.uk
Insights
For severe mucositis pain in children, adding ketamine to morphine patient-controlled analgesia (PCA) may improve pain relief. This combination therapy showed reduced morphine needs and minimal side effects in a study of pediatric cancer patients.
Area of Science:
- Pediatric Oncology
- Pain Management
- Clinical Pharmacology
Background:
- Mucositis is a painful condition affecting the digestive tract lining after cancer treatments.
- Severe mucositis pain can disrupt cancer therapy, making effective pain management crucial.
- Intravenous morphine, particularly via patient-controlled analgesia (PCA), is a primary treatment for severe mucositis pain.
Purpose of the Study:
- To review pain management strategies in 100 pediatric mucositis cases.
- To determine the effectiveness and side effects of morphine PCA for severe mucositis pain.
- To investigate the role of adjuvant ketamine therapy in cases with inadequate pain control.
Main Methods:
- A retrospective review of children with mucositis requiring intravenous opioid analgesia.
- Data collected over a 3-year period (May 2006 - April 2009).
- Analysis of morphine requirements, pain relief, and side effects, including the use of ketamine.
Main Results:
- Morphine PCA provided insufficient pain relief in 26% of cases, necessitating adjuvant ketamine.
- Children requiring ketamine had significantly higher morphine needs and tended to be older females.
- Ketamine addition was associated with reduced morphine consumption, better pain scores, and minimal side effects, with no hallucinations.
Conclusions:
- Children with severe mucositis experiencing escalating morphine requirements may benefit from ketamine added to their morphine PCA.
- Ketamine can be a valuable adjunct to morphine PCA for managing refractory pain in pediatric mucositis.
- This approach may help maintain cancer treatment continuity by improving pain control.
Objective:
We aimed to review the pain management in 100 episodes of severe mucositis in children and determine the incidence of associated side effects.
Background:
Mucositis is a painful, debilitating condition affecting the alimentary mucosa and occurs following many anticancer treatments. Severe pain associated with mucositis may necessitate reductions, delays or termination of anticancer therapy and so intravenous morphine, preferably by patient-controlled analgesia (PCA) is the treatment of choice.
Methods:
Retrospective review of consecutive episodes of mucositis in children requiring intravenous opioid analgesia over a 3-year period (May 2006-April 2009).
Results:
In 24/92 (26%) of cases, morphine PCA provided insufficient pain relief and children required adjuvant ketamine therapy. These children had rapidly increasing morphine requirements approaching 1000 mcg/kg/day by day 2 (more than double compared with children on morphine alone), were more likely to be female, and tended to be older (median [IQR] age 12 [6-12] years vs 7 [3-14] years). The addition of ketamine to the morphine PCA appears to be associated with reduced morphine consumption, improved pain scores, causing minimal side effects and no hallucinations.
Conclusions:
Children with severe mucositis who have escalating morphine requirements may benefit from the addition of ketamine to their morphine PCA.
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