Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities

Abstract

The opioid crisis in the United States has grown at an alarming rate. Children with cancer are at high risk for pain, and opioids are a first‐line treatment in this population. Accordingly, there is an urgent need to optimize pain management in children with cancer without contributing to the opioid crisis. This report details opportunities for this optimization, including clinical practice guidelines, comprehensive approaches to pain management, mobile health, and telemedicine. It is vital to balance appropriate use of analgesics with efforts to prevent misuse in order to reduce unnecessary suffering and minimize unintended harms.

Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows

“…However, there is growing recognition of the lack of adequate training in symptom management, specifically with opioids, among practitioners at all levels and in multiple specialties 14–20 . Furthermore, most state and federal clinical practice guidelines related to opioid prescribing exclude cancer patients 21 . As a result, many children and adults with cancer and sickle cell disease receive inadequate management of their pain 17,22–24 …”

“…[14][15][16][17][18][19][20] Furthermore, most state and federal clinical practice guidelines related to opioid prescribing exclude cancer patients. 21 As a result, many children and adults with cancer and sickle cell disease receive inadequate management of their pain. 17,[22][23][24] In this study, we sought to investigate the level of knowledge related to, and comfort with, opioid use for pain control among current trainees in PHO in the United States (US).…”

Guideline for Children With Cancer Receiving General Anesthesia for Procedures and Imaging

“…Patients who have received opioids for pain on a chronic basis before surgery due to their underlying disease may require much higher postoperative opioid doses than standard dosing guidelines developed for opioid-naive patients. While opioids play a critical role in the treatment of oncologic pain, opioid stewardship must be taken into account, and other methods of pain control should be considered when appropriate 39,40. For example, pain after limb-sparing surgery with a neuropathic pain component may be best treated with other medications and a combination of strategies 41,42.…”

“…While opioids play a critical role in the treatment of oncologic pain, opioid stewardship must be taken into account, and other methods of pain control should be considered when appropriate. 39,40 For example, pain after limb-sparing surgery with a neuropathic pain component may be best treated with other medications and a combination of strategies. 41,42 In addition to opioids, many pediatric oncology patients benefit from multimodal systemic analgesic approaches as well as continuous postoperative regional anesthesia infusions, using either peripheral nerve/plexus catheters or epidural catheters.…”

Design strategies for the development of mHealth services in healthcare of adolescents with cancer

“…The feeling of pain, in particular, may come from the underlying disease, but for most children, it is iatrogenic or caused by the treatment itself (16). Acute pain requires immediate intervention, as its underestimation can lead to chronic pain, increasing its levels while limiting the patient's subsequent cooperation during medical visits (17). Cancer-related chronic pain is also accompanied by a variety of negative consequences such as high rates of functional disability, emotional and behavioral difficulties (e.g.…”