Anesthesia & Intensive Care and Pain Relief & Supportive Care Unit, La Maddalena Cancer Center, Italy; Chair of Anesthesiology, University of Palermo, Italy.
Anesthesia & Intensive Care and Pain Relief & Supportive Care Unit, La Maddalena Cancer Center, Italy; Chair of Anesthesiology, University of Palermo, Italy.
Crit Rev Oncol Hematol. 2014 Jul;91(1):93-7. doi: 10.1016/j.critrevonc.2014.01.005. Epub 2014 Jan 24.
The aim of this review was to assess cancer pain management in children on the basis of research published in the last ten years. Nine were papers providing clinical data, with a minimum of ten patients. No controlled studies were found. Regardless of general principles and existing recommendations, clinical data should confirm the applicability of this concept. The trials published in the last years did not provide further information to improve cancer pain management in children, because of the experience and the low number of drugs used, reflecting only meaningful opinions of experts in the field. The amount and the quality of data still remain poor, as only 737 subjects (about 80 patients per year) were surveyed with open-label designs or retrospective analysis. No comparison among possible treatments or drugs has ever been performed. Most of these trials are short-lived and assessment of adverse effects is often problematic. The experience with opioids is quite limited, and adjuvants have been seldom assessed, unless for case reports which have not been considered in this analysis. The management of breakthrough pain has never been specifically evaluated. Further clinical trials are needed to evaluate dose equivalence, clinical efficacy and safety of opioid analgesics, differences in opioid response, adjuvants and other drugs commonly used to manage opioid-related adverse effects, and dose strengths necessary for most children.
本综述的目的是根据过去十年发表的研究评估儿童癌症疼痛管理。其中 9 篇为提供临床数据的论文，至少有 10 名患者。未发现对照研究。无论一般原则和现有建议如何，临床数据都应证实这一概念的适用性。过去几年发表的试验没有提供更多的信息来改善儿童癌症疼痛管理，因为经验和使用的药物数量有限，只反映了该领域专家的有意义的意见。数据的数量和质量仍然很差，只有 737 名受试者（每年约 80 名患者）接受了开放性设计或回顾性分析。从未对可能的治疗方法或药物进行过比较。这些试验大多是短期的，对不良反应的评估往往存在问题。阿片类药物的使用经验相当有限，辅助药物也很少被评估，除非是案例报告，这些报告没有在本分析中考虑。突破性疼痛的管理从未得到专门评估。需要进一步的临床试验来评估阿片类药物镇痛剂的剂量等效性、临床疗效和安全性、阿片类药物反应的差异、辅助药物和其他常用于治疗阿片类药物相关不良反应的药物，以及大多数儿童所需的剂量强度。
