Royal Marsden NHS Foundation trust, London, UK.
Curr Opin Support Palliat Care. 2020 Jun;14(2):100-106. doi: 10.1097/SPC.0000000000000492.
Continual refinement and further stratification of childhood cancer treatment has led to increased survivorship with recognized improvements in many long-term health outcomes. Despite this progress, persisting pain prevalence in childhood cancer survivors is increasing and emerging as a significant long-term health concern.
Currently, there is no guidance on how to approach and manage persisting pain in survivors of childhood cancer.
Clinicians should work with children and young people to optimize the management of pain and other symptoms on treatment. Focusing on an early post treatment screening for pain and other symptoms (including sleep and fatigue), and the role of on-going analgesic use. Follow-up should offer a multidisciplinary approach, aimed at lessening reliance on pharmacological approaches to pain management, addressing psychological concerns and promoting increased physical activity. The onus is on clinicians to mitigate the long-term risk of pharmacological reliance, particularly opioid dependency, in patients leaving their care and heading into adulthood. In this article, we highlight the emerging evidence of persisting pain in survivors of childhood cancer as a significant long-term health outcome and consider some initial principles of management.
儿童癌症治疗的不断改进和进一步分层导致了存活率的提高，并在许多长期健康结果方面得到了公认的改善。尽管取得了这一进展，但儿童癌症幸存者的持续性疼痛患病率仍在上升，并成为一个重大的长期健康问题。
目前，对于如何处理儿童癌症幸存者的持续性疼痛，尚无指导意见。
临床医生应与儿童和青少年合作，优化治疗期间的疼痛和其他症状的管理。重点关注治疗后早期筛查疼痛和其他症状（包括睡眠和疲劳），以及持续使用镇痛药的作用。随访应采用多学科方法，旨在减少对药物治疗疼痛管理的依赖，解决心理问题，并促进增加身体活动。临床医生有责任减轻患者离开治疗并进入成年期后长期依赖药物的风险，特别是对阿片类药物的依赖。在本文中，我们强调了持续性疼痛作为儿童癌症幸存者的一个重要长期健康结果的新出现证据，并考虑了一些初步的管理原则。
