Pharmacological management of cancer pain in children

The aim of this review was to assess cancer pain management in children on the basis of research published in the last ten years. Nine were papers providing clinical data, with a minimum of ten patients. No controlled studies were found. Regardless of general principles and existing recommendations, clinical data should confirm the applicability of this concept. The trials published in the last years did not provide further information to improve cancer pain management in children, because of the experience and the low number of drugs used, reflecting only meaningful opinions of experts in the field. The amount and the quality of data still remain poor, as only 737 subjects (about 80 patients per year) were surveyed with open-label designs or retrospective analysis. No comparison among possible treatments or drugs has ever been performed. Most of these trials are short-lived and assessment of adverse effects is often problematic. The experience with opioids is quite limited, and adjuvants have been seldom assessed, unless for case reports which have not been considered in this analysis. The management of breakthrough pain has never been specifically evaluated. Further clinical trials are needed to evaluate dose equivalence, clinical efficacy and safety of opioid analgesics, differences in opioid response, adjuvants and other drugs commonly used to manage opioid-related adverse effects, and dose strengths necessary for most children. (C) 2014 Elsevier Ireland Ltd. All rights reserved.