[Pain management in advanced pediatric cancer patients--a proposal of the two-step analgesic ladder].

Pain treatment for 17 pediatric cancer patients in our institution was evaluated and disirable cancer pain management for children was discussed. Most of the patients (aged 1-17 years) suffering severe pain for about one month were in the advanced stage of the malignant diseases (e.g. leukemia). The pain etiology was mostly tumor-associated while therapy-related pain accounted for 23.5%. These pains were treated with NSAIDs or pentazocine before the consultation with inadequate relief. Oral morphine sulfate or continuous intravenous morphine chloride was administered to 16 patients with successful pain relief and side effects such as nausea (52.9%) and drowsiness (41.2%). It took 5.5 days on average until adequate pain control methods were determined. It is known that most NSAIDs frequently used for pediatric pain possibly cause adverse effects such as platelet dysfunction or mucous membrane injury with a suppository, which could lead to a fatal disorder in clinically ill pediatric cancer patients. Moreover sufficient doses for the pain relief are not necessarily given to the pediatric patients because of a limit to the dosage of NSAIDs. The period of pediatric cancer pain in which the patient require a methodical treatment and receive benefit from pain relief is relatively short in the advanced stage, not to mention the early stage in which chemotherapy is efficacious against cancer disease itself. Therefore, to obtain effective pain control within a short time, the authors propose the pain management for advanced pediatric cancer patients by the two-step analgesic ladder prescribing weak or strong opioid analgesics first, adapted from the three-step ladder of the WHO Cancer Pain Relief, 1986.