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Comprehensive Handbook of Childhood Cancer and Sickle Cell DiseaseA Biopsychosocial Approach$
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Ronald T. Brown

Print publication date: 2006

Print ISBN-13: 9780195169850

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780195169850.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 20 June 2021

Pain and Procedure Management

Pain and Procedure Management

(p.119) 7 Pain and Procedure Management
Comprehensive Handbook of Childhood Cancer and Sickle Cell Disease

Paola M. Conte

Gary A. Walco

Oxford University Press

Pediatric cancer treatment has seen an incredible increase in survival rates, so that, overall, 75% of children diagnosed with cancer will achieve longterm survival and cure (Ries et al., 2003). An estimated 9,000 new cases of childhood cancer are expected to occur each year (American Cancer Society, 2003), among which one third involve leukemia and one quarter involve a central nervous system (CNS) tumor. Other diagnoses include lymphoma, sympathetic nerve tumor, soft tissue sarcoma, bone tumor, germ cell tumor, and retinoblastoma (Gustafsson, Langmark, Pihkala, Verdier, & Lilleaas, 1998). Although less than 1% of all cancer cases are children (Stiller & Draper, 1998), pediatric cancer causes more deaths among children in industrialized nations than any other disease and after accidents is the leading cause of death among children 1–14 years of age (American Cancer Society, 2003). Improvement in survival rates is the result of increasingly aggressive treatment protocols. With these advances, however, has come greater need for supportive care to address the array of treatment adverse side effects, including pain (Gustafsson et al., 1998). In the United States, 94% of children are treated at centers that are members of a collaborative clinical trials research consortium (American Cancer Society, 2003), implying that treatment protocols, including approaches to preventing and managing adverse side effects, are the norm. To a great degree, however, management of pain has been exempt from this standardized and rigorous approach. This is somewhat ironic and unfortunate as children with cancer reported pain to be the most feared symptom they experience (Enskar, Carlsson, Golsater, Hamrin, & Kreuger, 1997). Undertreatment of pain in children is hardly unique to the cancer population (Schechter, Berde, & Yaster, 2003), and is generally because of limited information available to clinicians, persistence of misinformation about pain in children, and attitudes that denigrate adequate pain management. For example, there is a lack of research on pharmacological interventions for pain in children. Although it is agreed that randomized clinical trials for pain prevention and management would be helpful to address issues of safety, efficacy, pharmacodynamics, and pharmacokinetics in pediatrics, the pragmatics and ethics of such research, especially in very young children, have limited such progress (Berde, Brennan, & Raja, 2003).

Keywords:   analgesics, distraction techniques, fentanyl, hydromorphone, ketamine, lumbar puncture (LP), meperidine

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