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Novel Approaches for Treating Pain in Children

  • Palliative Medicine (A Jatoi, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

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.

Summary

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.

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References

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

  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. Ciechanowicz S, Patil V. Review article: lipid emulsion for local anesthetic toxicity. Anesthesiol Res Pract. 2012;2012:1–11. https://doi.org/10.1155/2012/131784.

    CAS  Google Scholar 

  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). https://doi.org/10.4172/2155-6148.1000697.

  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. https://doi.org/10.1002/14651858.CD009642.pub2.

  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. 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. https://doi.org/10.2478/acve-2018-0009.

    Google Scholar 

  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.

    Google Scholar 

  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.

    PubMed  Google Scholar 

  9. Hocking G, Cousins MJ. Ketamine in chronic pain management. Anesth Analg. 2004;97:1730–9.

    Google Scholar 

  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.

    PubMed  Google Scholar 

  11. Dallimore D, Anderson BJ, Short TG, Herd DW. Ketamine anesthesia in children – exploring infusion regimens. Pediatr Anesth. 2018;18:708–14.

    Google Scholar 

  12. Elia N, Tramèr MR. Ketamine and postoperative pain – a quantitative systematic review of randomized trials. Pain. 2005;113:61–70.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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. https://doi.org/10.1016/j.epain.2009.09.005.

    CAS  Google Scholar 

  15. •• Wong S, Wilens T. Medical cannabinoids in children and adolescents. A systematic review. Pediatrics. 2017;140(5):e20171818. https://doi.org/10.1542/peds.2017.1818 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.

    PubMed  Google Scholar 

  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. https://doi.org/10.1001/jama.2015.6358 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.

    CAS  PubMed  Google Scholar 

  17. Hosking RD, Zaijicek JP. Therapeutic potential of cannabis in pain medicine. Br J Anaesth. 2008;101(1):59–68. https://doi.org/10.1093/bja/aen119.

    CAS  PubMed  Google Scholar 

  18. Basker S, Singh G, Jacob R. Clonidine in pediatrics – a review. Indian J Anaesth. 2009;53:270–80.

    PubMed  PubMed Central  Google Scholar 

  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. https://doi.org/10.1136/bmjopen-2016-013858.

    PubMed  PubMed Central  Google Scholar 

  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. 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. https://doi.org/10.1111/j.1460-9592.2006.02185.x.

    Google Scholar 

  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. https://doi.org/10.1016/j.peds.2015.10.013 Nice article that assesses the use of gabapentin in the NICU for neurologic and gastrointestinal morbidities.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  PubMed Central  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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.

    CAS  Google Scholar 

  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. https://doi.org/10.1016/jpainsymman.2009.03.00830.

    CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  31. Worsley MH, MacLead AD, Brodie MJ, Asbury AJ, Clark C. Inhaled fentanyl as a method of analgesia. Anaesthesia. 1990;45(6):449–51.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Palliative Medicine, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada

    William Splinter

  2. Roger Neilson’s House, Ottawa, Ontario, Canada

    William Splinter

  3. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada

    William Splinter

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Correspondence to William Splinter.

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Splinter, W. Novel Approaches for Treating Pain in Children. Curr Oncol Rep 21, 11 (2019). https://doi.org/10.1007/s11912-019-0766-6

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  • DOI: https://doi.org/10.1007/s11912-019-0766-6

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