Pain in pediatric oncology : Diagnostics and treatment

Abstract: Pain treatment is a crucial aspect in the care of children with cancer and several studies demonstrate inefficient pain treatment. The general aims of the thesis were to identify the current pain problems in pediatric oncology, and to see whether specific interventions could improve the situation. We wanted to evaluate all questions from the perspectives of children, parents, and professionals.The pain problems were surveyed through a national questionnaire study for nurses and physicians, and a regional structured interview study for children and parents, Nasal midazolam spray was investigated in a randomized, double-blind, placebo-controlled, cross-over trial, and conscious sedation (CS) and general anesthesia (GA) in lumbar puncture (LP) were compared in a randomized, cross-over study.Pain was still a common problem in pediatric oncology. Treatment- and procedure-related pain were greater problems than cancer-related pain and most pain experienced by children with cancer had iatrogenic origin. Pain evaluation and measurement were unsatisfactory. According to both professionals and families, pain could be managed more effectively than it is at present.Nasal midazolam spray offered relief to children anxious about minor medical procedures such as insertion of a needle in a subcutaneously implanted intravenous port, venous blood sampling, venous cannulation, etc. Its use, however, may be limited by nasal discomfort in some children. Outcome for CS and GA in LP were similar. Although there were failures with the CS model, most preferred it to GA. LP in CS also saved time and medical resources. Thus it was shown that CS is a good alternative to GA in LP in most children.The results and conclusions in the thesis imply that pain- diagnostics and treatment can be improved through increased: 1, education of professionals; 2, repeated information to families about pain and pain treatment; 3, cooperation with children and parents; 4, use of pain- analysis and measurement; 5, documentation of analysis and measurement ; 6, establishment of explicit memoranda and routines for pain- diagnostics and treatment; 7, cooperation between nurses and physicians in the implementation of these routines; 8, use of sedation, e.g. nasal midazolam spray in children anxious about minor medical procedures; 9, use of CS in LP in all children who accept it; and 10, liberality to contacts with pain treatment teams.