Management of pain in leukemic children using the WHO analgesic ladder.
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Date
2010-06
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Abstract
Objective. To ascertain the effectiveness of WHO analgesic ladder in pain management in children with leukemia.
Methods. Children with leukemia who were referred to a pain and palliative care clinic attached to the Department of
Pediatrics of a medical teaching hospital during a period of 6 months, were included in the study.
Results. Thirty nine (39) children, who constituted 64% of children on treatment for leukemia, required referral to pain and
palliative care services during the study period. Of these 92% had Acute Lymphocytic Leukemia (ALL) and 8% had Acute Non
Lymphocytic Leukemia (ANLL). 95% of children had nociceptive pain and 5% had neuropathic pain. Step – 1 analgesia was
effective in 12 (31%) children and 21 (54%) could be managed with Step – 2 analgesia. Step – 3 analgesia was required in
only 6 (15%) children. Step 3 analgesia was required in children with neuropathic pain and bone pain.
Conclusions. WHO analgesic ladder is effective in managing pain in children with leukemia. Majority of cases of cancer pain
in children could be managed by the treating physician using non-opioids, weak opioids and adjuvants as per the WHO
guidelines. Children with bone pain and neuropathic pain may require referral to specialist services and use of strong opioids
like morphine. The study emphasizes the need for establishing specialist pain management services in all centres where children with cancer are treated.
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Keywords
Children, Leukemia, Pain, WHO analgesic ladder
Citation
Geeta M G, Geetha P, Ajithkumar V T, Krishnakumar P, Kumar K Suresh, Mathews Lulu. Management of pain in leukemic children using the WHO analgesic ladder. Indian Journal of Pediatrics. 2010 June; 77(6): 665-668.