Current Oncology Reports

, 21:11 | Cite as

Novel Approaches for Treating Pain in Children

  • William SplinterEmail author
Palliative Medicine (A Jatoi, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Palliative Medicine


Purpose of Review

Good pain management in children, especially those at end of life, is a crucial component of palliative medicine. The current review assesses some of the new and/or innovative ways to manage pain in children. The article focuses on some recent medications/pharmaceutical options such as cannabinoids and also innovative ways to administer medication to children, such as intranasal and inhalation.

Recent Findings

Current approaches to pain management now include (1) new uses of old drugs such as ketamine and lidocaine, (2) use of new drugs/medications such as cannabinoids, and (3) creative use of old technology such as atomizers, intranasal drops, and inhalation.


Typically, novel approaches to care rarely start in pediatrics or palliative care. The current review has presented some new and old drugs being utilized in new and old ways.


Pain Children Palliative care Lidocaine Magnesium Clonidine Dexmedetomidine Cannabis 5THC CBD Ketamine Gabapentin Intranasal Atomizer Inhaled 


Compliance with Ethical Standards

Conflict of Interest

The author declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Eipe N, Gupta S, Penning J. Intravenous lidocaine for acute pain: an evidence-based clinical update. BJA Educ, Lidocaine Infusion for Neuropathic/Intractable Pain Policy. 2016;16(9):292–8.Google Scholar
  2. 2.
    Ciechanowicz S, Patil V. Review article: lipid emulsion for local anesthetic toxicity. Anesthesiol Res Pract. 2012;2012:1–11. Scholar
  3. 3.
    Kandil E, Melikman E, Adinoff B. Lidocaine infusion: a promising therapeutic approach for chronic pain. J Anesth Clin Res. 2017;8(1): retrieved March 16, 2017).
  4. 4.
    Kranke P, Jokinen J, Pace NL, Schnabel A, Hollmann MW, Hahnenkamp K, et al. Continuous intravenous perioperative lidocaine infusion for post-operative pain and recovery (review). Cochrane Database Syst Rev. 2015;(7):CD009642.
  5. 5.
    Na HS, Ryu JH, Do SH. The role of magnesium in pain. In: Magnesium in the central nervous system. Adelaide: University of Adelaide Press; 2011. p. 157–65.Google Scholar
  6. 6.
    Vujovic S, Vuckovic A, Stojanovic R, Divac N, Medic B, Srebro D, et al. Involvement of serotongergic, noradrenergic and gabanergic systems in the antinociceptive effect of ketamine-magnesium sulfate combination in acute pain. Acta Vet (Beograd). 2018;68(1):108–18. Scholar
  7. 7.
    Finkel JC, Pestieau SR, Quezado ZMN. Ketamine as an adjuvant for treatment of cancer pain in children and adolescents. J Pain. 2017;8(6):515–21.CrossRefGoogle Scholar
  8. 8.
    Goldberg ME, Domsky R, Scaringe D, Hirsh R, Dotson J, Sharaf I, et al. Multi-day low dose ketamine infusion for the treatment of complex regional pain syndrome. Pain Physician. 2005;8:175–9.PubMedGoogle Scholar
  9. 9.
    Hocking G, Cousins MJ. Ketamine in chronic pain management. Anesth Analg. 2004;97:1730–9.CrossRefGoogle Scholar
  10. 10.
    Shirani P, Salamone AR, Schulz PE, Edmondson EA. Ketamine treatment for intractable pain in a patient with severe refractory complex regional pain syndrome: a case report. Pain Physician. 2008;11(3):339–42.PubMedGoogle Scholar
  11. 11.
    Dallimore D, Anderson BJ, Short TG, Herd DW. Ketamine anesthesia in children – exploring infusion regimens. Pediatr Anesth. 2018;18:708–14.CrossRefGoogle Scholar
  12. 12.
    Elia N, Tramèr MR. Ketamine and postoperative pain – a quantitative systematic review of randomized trials. Pain. 2005;113:61–70.CrossRefGoogle Scholar
  13. 13.
    Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjunct analgesic to opioids; a quantitative and qualitative systematic review. Anesth Analg. 2004;99:482–95.CrossRefGoogle Scholar
  14. 14.
    Blonk MI, Koder BG, van den Bemt PM, Huygen FJ. Use of oral ketamine in chronic pain management: a review. E J Pain. 2010;14(5):466–72. Scholar
  15. 15.
    •• Wong S, Wilens T. Medical cannabinoids in children and adolescents. A systematic review. Pediatrics. 2017;140(5):e20171818. This is another meta-analysis of the use of cannabinoids, but with a focus on children and adolescents and like the article noted above, is a key article in the current pediatric literature. CrossRefPubMedGoogle Scholar
  16. 16.
    •• Whiting PF, Wolff RF, Deshpande S, di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for medical use. A systematic review and meta-analysis. JAMA. 2015;313(24):2456–73. This is a recent review of the medical use of cannabinoids. It has been massively viewed and cited and is clearly a key article in the current literature. CrossRefPubMedGoogle Scholar
  17. 17.
    Hosking RD, Zaijicek JP. Therapeutic potential of cannabis in pain medicine. Br J Anaesth. 2008;101(1):59–68. Scholar
  18. 18.
    Basker S, Singh G, Jacob R. Clonidine in pediatrics – a review. Indian J Anaesth. 2009;53:270–80.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Hayden JC, Dawkins I, Breatnach C, Leacy FP, Foxton J, Healy M, et al. Effectiveness of α2agonists for sedation in paediatric critical care: study protocol for a retrospective cohort observational study. BMJ Open. 2017;7(5):e013858. Scholar
  20. 20.
    Hauer J, Duncan J, Scullion BF. In: Team PAC, editor. Pediatric pain and symptom management guidelines. Boston: Boston Children’s Hospital Dana Farber Cancer Institute; 2014.Google Scholar
  21. 21.
    Schmidt AP, Valinetti EA, Bandeira D, Bertacchi MF, Simoes CM, Otavio OC. Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children. Pediatr Anesth. 2007;17:667–74. Scholar
  22. 22.
    • Edwards L, DeMeo S, Hornik CD, Cotton CM, Smith PB, Pizoli C, et al. Gabapentin use in the neonatal intensive care unit. J Pediatr. 2016;169:310–2. Nice article that assesses the use of gabapentin in the NICU for neurologic and gastrointestinal morbidities. CrossRefPubMedGoogle Scholar
  23. 23.
    Chiaretti A, Barone B, Rigante D, et al. Intranasal lidocaine and midazolam for procedural sedation in children. Arch Dis Child. 2011;96:160–3.CrossRefGoogle Scholar
  24. 24.
    Deshmukh PV, Kulkarni SS, Parchandaker MK, Sikchi SP. Comparison of preanesthetic sedation in pediatric patients with oral and intranasal midazolam. J Anaesthesiol Clin Pharmacol. 2016;32:353–8.CrossRefGoogle Scholar
  25. 25.
    Miller JW, Balyan R, Dong M, Mahmoud M, Lam JE, Pratap JN, et al. Does intranasal dexmedetomidine provide adequate plasma concentrations for sedation in children: a pharmacokinetic study. Br J Anaesth. 2018;120(5):1056–65.CrossRefGoogle Scholar
  26. 26.
    • Pieper L, Wager J, Zernikow B. Intranasal fentanyl for respiratory distress in children and adolescents with life-limiting conditions. BMC Palliat Care. 2018;17:106 Very educational, recent article on intranasal fentanyl use in children at end of life. Although used for respiratory symptoms, much can be applied to pain management. CrossRefGoogle Scholar
  27. 27.
    Foster D, Upton R, Christrup L, Popper L. Pharmacokinetics and pharmacodynamics of intranasal versus intravenous fentanyl in patients with pain after oral surgery. Annals Pharmacother. 2008;42(10):1380–7.CrossRefGoogle Scholar
  28. 28.
    Krajnik M, Podolec Z, Siekierka M, Sykutera M, Pufal E, Sobanski P, et al. Morphine inhalation by cancer patients: a comparison of different nebulization techniques using pharmacokinetic, spirometric, and gasometric parameters. J Pain Symptom Manag. 2009;38(5):747–57. CrossRefGoogle Scholar
  29. 29.
    Bounes V, Ducasse JL, Bona AM, et al. Nebulized morphine for analgesia in an emergency setting. J Opioid Manag. 2009;5(1):23–6.CrossRefGoogle Scholar
  30. 30.
    MacLeod DB, Habib AS, Keita I, et al. Inhaled fentanyl aerosol in healthy volunteers: pharmacokinetics and pharmacodynamics. Anesth Analg. 2012;115(5):1071–7.CrossRefGoogle Scholar
  31. 31.
    Worsley MH, MacLead AD, Brodie MJ, Asbury AJ, Clark C. Inhaled fentanyl as a method of analgesia. Anaesthesia. 1990;45(6):449–51.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Palliative MedicineChildren’s Hospital of Eastern OntarioOttawaCanada
  2. 2.Roger Neilson’s HouseOttawaCanada
  3. 3.Department of Anesthesiology and Pain MedicineUniversity of OttawaOttawaCanada

Personalised recommendations