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Management of breakthrough pain in children with cancer

Stefan J Friedrichsdorf1, Andrea Postier2

  • 1Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, USA ; University of Minnesota Medical School, Minneapolis, MN, USA.

Journal of Pain Research
|March 19, 2014
PubMed

Insights

Breakthrough pain in pediatric cancer patients is common and undertreated. Current recommendations favor multimodal analgesia with immediate-release opioids, but more research is needed.

Area of Science:

  • Pediatric Oncology
  • Pain Management
  • Palliative Care

Background:

  • Breakthrough pain in children with cancer is a severe exacerbation of pain despite controlled background analgesia.
  • This type of pain is prevalent, underassessed, and undertreated in pediatric cancer patients.
  • Existing data on management strategies are limited, highlighting a significant knowledge gap.

Purpose of the Study:

  • To highlight the scarcity of research on breakthrough pain management in pediatric cancer.
  • To present current clinical experience-based treatment protocols.
  • To advocate for future research in this critical area.

Main Methods:

  • Review of existing literature and clinical experience.
  • Description of recommended multimodal analgesia strategies.
  • Discussion of pharmacologic options and their limitations.

Main Results:

  • No randomized controlled trials exist for managing breakthrough pain in pediatric cancer.
  • Increasing scheduled opioid doses risks oversedation and is less effective.
  • Multimodal analgesia with immediate-release opioids via patient-controlled analgesia (PCA) pumps is the most common effective strategy.

Conclusions:

  • There is a critical need for more research into effective breakthrough pain management for children with cancer.
  • Current effective strategies involve rapid-acting opioids, often administered via PCA.
  • Transmucosal fentanyl formulations are not yet recommended for this population due to lack of pediatric data.

Keywords:
adjuvant analgesiabreakthrough paincancerintegrative medicineopioidpediatric

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