Pain management in pediatric cancer from the national survey of Japanese Pediatric Leukemia/lymphoma Study Group

Abstract

Background: Pharmacological pain management issues in pediatric cancer patients in Japan have not been identified.

Methods: A cross-sectional investigation at 155 institutions belonging to the Japanese Pediatric Leukemia/Lymphoma Study Group (JPLSG) was conducted between October 2015 and March 2016 by web survey, addressing pharmacological pain management issues in each institutional policy.

Results: The eligible responses were obtained from 81 institutions (response rate, 52%). Among these institutions, 98% provided pain management by pediatric oncologists, and 37% were aware of and implemented the World Health Organization (WHO) guidelines published in 2012. The first choice of analgesics for mild pain was oral acetaminophen. For more-than-moderate pain, low-dose strong opioids or pentazocine were used at some institutions. Immediate-release oral morphine and transdermal fentanyl were the first choices among strong opioids in cases without blood access in 48% and 47% of institutions, respectively. On the other hand, intravenous morphine and intravenous fentanyl were the first choices in cases with blood access in 80% and 68% of institutions, respectively. Pregabalin was administered for neuropathic pain. Steroid was administered for bone pain. Radiation therapy and nerve block were also performed at 36% and 7% institutions, respectively.

Conclusions: Pediatric oncologists were the main providers of pharmacological pain management. Although some off-label analgesics and adjuvants, as well as radiation therapy and nerve block are not mentioned in the guidelines, they were actually used in some hospitals. These should be carefully investigated for indications, proper use, efficacy, and safety.