Douglas Claire, Morse James D, Anderson Brian J
Department of Anaesthesia, Starship Children's Hospital, Auckland, New Zealand.
Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
Paediatr Anaesth. 2025 Apr;35(4):302-309. doi: 10.1111/pan.15063. Epub 2025 Jan 6.
Children who have received chemotherapy and/or radiotherapy treatment resulting in neutropenia can suffer painful mucositis. We explored the relationship between pain score and white cell count in children with mucositis due to immunosuppression and assessed the influence of opioid and ketamine analgesia.
Children with mucositis nursed in the pediatric oncology and hematology ward were invited to partake in this observational study following referral to the pediatric pain service for intravenous analgesia. Pain scores, white cell count, neutrophil count, and analgesia requirements were recorded daily until intravenous analgesia was either stopped or transitioned to oral analgesia. Data were analyzed using nonlinear mixed effects models that sought a relationship between white cell count and pain score using a sigmoid maximal effect (E) model. The impact of analgesic use on pain score was determined. The temporal relationship between white cell count and pain score was characterized by using a delayed effect model with an equilibration half-time.
Fifty children were enrolled in the study from January 2022 to December 2023. The equilibration half-time relating the rise in white cell count and pain response was 0.29 days. The initial pain score (estimated in those children already started on treatment with paracetamol and tramadol) was 6.3 (maximum pain 10). The maximum pain reduction was 59% of that initial pain score. Morphine and ketamine further reduced pain; the maximum response for opioids was 38% reduction and that for ketamine was 11%.
Pain relief from mucositis is related to an increase in white cell count after a period of severe neutropenia, where white cell count is a surrogate for neutrophil count. There is a delay in analgesic response of approximately 1 day. This analgesic response to increasing white cell count had greater dominance than analgesia achieved using either opioids or ketamine.
接受化疗和/或放疗导致中性粒细胞减少的儿童可能会遭受疼痛性粘膜炎。我们探讨了免疫抑制所致粘膜炎患儿疼痛评分与白细胞计数之间的关系，并评估了阿片类药物和氯胺酮镇痛的影响。
在儿科肿瘤学和血液学病房护理的粘膜炎患儿在被转介至儿科疼痛服务部门接受静脉镇痛后，受邀参与这项观察性研究。每天记录疼痛评分、白细胞计数、中性粒细胞计数和镇痛需求，直至静脉镇痛停止或转换为口服镇痛。使用非线性混合效应模型进行数据分析，该模型使用S形最大效应（E）模型寻找白细胞计数与疼痛评分之间的关系。确定镇痛药物使用对疼痛评分的影响。通过使用具有平衡半衰期的延迟效应模型来表征白细胞计数与疼痛评分之间的时间关系。
2022年1月至2023年12月期间，50名儿童纳入研究。白细胞计数升高与疼痛反应相关的平衡半衰期为0.29天。初始疼痛评分（在已开始使用对乙酰氨基酚和曲马多治疗的儿童中估计）为6.3（最大疼痛为10）。最大疼痛减轻为初始疼痛评分的59%。吗啡和氯胺酮进一步减轻了疼痛；阿片类药物的最大反应是疼痛减轻38%，氯胺酮为11%。
在经历一段严重中性粒细胞减少期后，粘膜炎疼痛缓解与白细胞计数增加有关，其中白细胞计数可作为中性粒细胞计数的替代指标。镇痛反应有大约1天的延迟。这种对白细胞计数增加的镇痛反应比使用阿片类药物或氯胺酮所实现的镇痛效果更具优势。
