A survey of pain services for pediatric oncology patients: their composition and function

The purpose of this survey was to examine the composition and function of pain services/teams at facilities that provide pain management services to pediatric oncology patients across the United States. A questionnaire was mailed to facilities identified by the 1994 Pain Facilities Directory as providing pain services to cancer patients. Thirty-five facilities that identified oncology patients as one of the primary pediatric populations treated at their institution were the focus of this study. Eight facilities that managed bone marrow aspirations and/or lumbar punctures for pediatric oncology patients also participated in a telephone interview regarding analgesia/sedation practices for procedure-related pain. Provision of direct patient care was a primary function of the pain services surveyed, although delivery of services varied across settings. Postoperative and chronic pain were the most frequent reasons for referral. Only 17% and 3% of facilities had established written standard guidelines for pharmacological and nonpharmacological approaches to pain management, respectively. Most facilities reported using a local anesthetic and conscious sedation to manage bone marrow aspiration and lumbar punctures. Implications from these findings and recommendations for provision of pediatric pain services are discussed.