CRYSTAL CITY, Va--Pain due to cancer or cancer treatments or procedures can present special problems in pediatric patients, making life more difficult for everyone who must deal with the children, including the oncologist, Jo Eland, RN, PhD, said at the 25th Anniversary Conference of the Candlelighters Childhood Cancer Foundation.
For example, childhood leukemia patients must undergo lumbar puncture and blood aspiration every month for 18 months. "When you tell children it's time to go to the hospital, many go nuts," said Dr. Eland, associate professor of nursing, University of Iowa. "They hide in closets. The parents have to drag them into the car and then they come screaming into the clinic." Following the procedure, the children may have nightmares.
Fortunately, 85% of cancer pain could easily be relieved with existing knowledge and drugs, Dr. Eland said. For example, at Minneapolis Children's Hospital, at least 1,000 pediatric patients have undergone lumbar puncture and blood aspiration under the influence of pro-pofol (Diprivan), a short-acting general anesthetic.
These children have no frightful memories, and they are very cooperative, she said, recounting how one 4 year old, experienced with the drug, cheerfully greeted his physician when it was time for the procedures.
Alternatively, midazolam(Drug information on midazolam) (Versed), a benzodiazepine, can be used very effectively with morphine(Drug information on morphine) or fentanyl(Drug information on fentanyl) for bone marrows and lumbar punctures if one does not want to put the patient to sleep, she said.
One method to check pain that is widely used in adult cancer medicine, but neglected in pediatric oncology, is the use of "caines," nerve blocking agents such as lidocaine(Drug information on lidocaine) and procaine(Drug information on procaine). The problem is that they sting, Dr. Eland said. But a new nerve blocker, EMLA (prilocaine plus lidocaine), comes in ointment form and doesn't sting. "It's great for port access, PIC lines, and chest tubes," she said.
One application lasts for 4 hours, but it takes an hour to become effective. One child "demanded it before any procedure," Dr. Eland said, and when the doctor told him he'd have to wait an hour, he said, "Fine, I'll go play."