Interventional Pain Management for the Pediatric Cancer Patient: A Literature Review

Le-Short, Christina; Katragadda, Kavya; Nagda, Neil; Farris, David; Gelter, Marianne Halphen

doi:10.3390/children9030389

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…Underutilization of interventional approaches for pain is of concern, especially in view of our findings that highlight their analgesic efficacy as reflected by decreased PS and opioid utilization, safety, and benefits of these regional pain management interventions as efforts toward increasing QoL during EoL care for children with cancer. Our findings suggestive of underutilization of interventional pain management in pediatric oncology are consistent with those of a recent review article in pediatric oncology ( 19 ), which supported the fact that interventional approaches are typically reserved for refractory pain unresponsive to noninvasive treatment. Similarly, a review of literature from 1980 to 2012 indicated that although regional techniques are usually considered only in the limited context of failure of systemic treatments and/or intolerable medication side effects, their associated risks are often acceptable when the potential benefits are consistent with the overall goals of care ( 20 ).…”

Section: Discussionsupporting

confidence: 89%

Regional blocks for pain control at the end of life in pediatric oncology

et al. 2023

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BackgroundPain management at the end of life is a fundamental aspect of care and can improve patients' quality of life. Interventional approaches may be underutilized for pediatric cancer patients.ObjectiveTo describe a single institution's 10 years of experience with regional pain management at the end of life in pediatric oncology.MethodsA retrospective cohort study of 27 patients with pediatric cancer who died between April 2011 and December 2021 and received continuous nerve block (CNB) catheters or single-shot nerve blocks (SSBs) during their last three months of life. The type of blocks, analgesic efficacy, and palliative care involvement were evaluated.ResultsTwenty-two patients (81.5%) had solid tumor diagnoses, including carcinomas, sarcomas, and neuroblastoma. Most (59%) patients received CNB catheters, and 12 patients (44%) received SSBs for pain control. The mean pain score decreases for CNB catheters and SSBs after interventions were −2.5 and −2.8, respectively, on an 11-point scale. Decreases in opioid patient-controlled analgesia dosing requirements were noted in 56% of patients with CNB catheters; likewise, in 25% of patients with SSBs at 24 h and in 8% at 5 days after interventions. Nearly all patients had PC involvement and received care from pain specialists (96% and 93%, respectively). Twenty-three (85%) had physician orders for scope of treatment orders completed before death.ConclusionRegional pain control interventions can be effective and safe for relieving regional pain and suffering in dying children and young adults. The collaboration between palliative care and pain management specialists at the end of life can help alleviate suffering and improve quality of life.

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Section: Discussionsupporting

confidence: 89%

Regional blocks for pain control at the end of life in pediatric oncology

et al. 2023

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“…Use of interventions is typically done as a "last resort" for refractory pain nonresponsive to noninvasive therapies. 49 F I G U R E 3 Flowchart for assessment of children presenting with chronic pain after radiation therapy.…”

Section: Manag Ement Of R Adiation -Induced Chronic Painmentioning

confidence: 99%

“…The management of acute cancer-related pain in children has been extensively described, with guidelines surrounding use of opioids. 49 However, it is recognized that management of chronic pain is more complex and there is a reluctance by some parents and providers to give opioids long-term due to fear of side effects. 50 Assessing the etiology of the pain is important; with knowledge of the location of the primary tumor and the sites that have received radiotherapy, the practitioner would be better able to prescribe management tailored toward the child's needs.…”

Section: Manag Ement Of R Adiation -Induced Chronic Painmentioning

confidence: 99%

“…Use of interventions is typically done as a “last resort” for refractory pain nonresponsive to noninvasive therapies 49 . Such interventions include peripheral nerve blocks or plexus blocks, intrathecal infusions or intrathecal neurolysis, cordotomy, cryoablation, and kyphoplasty.…”

Section: Management Of Radiation‐induced Chronic Painmentioning

confidence: 99%

“…The management of acute cancer‐related pain in children has been extensively described, with guidelines surrounding use of opioids 49 . However, it is recognized that management of chronic pain is more complex and there is a reluctance by some parents and providers to give opioids long‐term due to fear of side effects 50 .…”

Section: Management Of Radiation‐induced Chronic Painmentioning

confidence: 99%

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Overview of radiotherapy‐induced chronic pain in childhood cancer survivors: A narrative review

Chua

Vig

2023

Paediatric and Neonatal Pain

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Radiotherapy is an important aspect of oncological treatment in several childhood cancers. However, radiotherapy is known to have numerous side effects, including detrimental effects on growth, neurocognitive impairment, and the development of secondary malignancies. One less studied long-term side effect of pediatric radiotherapy treatment is chronic pain. While the short-term toxicities of radiotherapy resolve over a few weeks to months, the chronic pain caused by radiotherapy-induced tissue damage can significantly affect children's quality of life. As long-term childhood cancer survivors age into adulthood, they are typically followed up by a wide variety of doctors, not all of whom may be familiar with radiotherapy-induced chronic pain and its management. The aim of this review is to discuss the various common manifestations of radiotherapy-related pain in children, as well as ways to identify and manage these.Common radiotherapy-related side effects leading to chronic pain symptoms include radiation fibrosis, enteritis, dermatitis, lymphedema, neuropathic pain, and effects on bone development. The pathophysiology, evaluation and management of these are briefly summarized in this review. This is followed by an overview of radiotherapy techniques that allow greater sparing of normal tissue, minimizing future painful side effects. Finally, the assessment of pain in children is described, as well as strategies for management, and red flag symptoms that should prompt urgent specialist referral. In conclusion, a good understanding of the long-term side effects of radiotherapy treatment in children is essential for the various medical professionals that follow-up the child in the years after treatment. For young children, the evaluation of pain is in itself a challenge, and effects on growth, development, and learning are crucial. For older children, social and psychological factors become increasingly important. As radiation therapy techniques continue to advance, the spectrum and incidence of chronic pain syndromes may change over time.

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Palliative Care in Children and Young People

Chong,

Liow

2024

Managing Pain in Children and Young People

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Interventional Pain Management for the Pediatric Cancer Patient: A Literature Review

Cited by 9 publications

References 30 publications

Regional blocks for pain control at the end of life in pediatric oncology

Regional blocks for pain control at the end of life in pediatric oncology

Overview of radiotherapy‐induced chronic pain in childhood cancer survivors: A narrative review

Palliative Care in Children and Young People

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