title: [Feasibility to treat pediatric cancer pain with analgesics for adults and their efficacy].
abstract: OBJECTIVE
  Lacking enough knowledge of pediatric cancer pain and pediatric dosage form of analgesics, current treatment of pediatric cancer pain in China is unsatisfactory. This study was to probe the efficacy and safety of treating pediatric cancer pain with analgesics for adults through summarizing the experience of diagnosis and treatment in Cancer Center of Sun Yet-sen University.
  
  
  METHODS
  Basing on the components and the endurable dosage of each component for children, we formulated the appropriate dosage and usage of a few analgesics (including sustained release tablets of morphine, oxycodone and transdermal fantanyl) available in China, most of which were used in adults. Cancer pain of 139 children with newly diagnosed tumors were treated according to the World Health Organization (WHO) analgesic ladder, including 19 cases of mild pain, 41 cases of moderate pain and 79 cases of severe pain. Efficacy and adverse events were evaluated.
  
  
  RESULTS
  Of the 139 patients, 104 (74.8%) were treated with analgesics of 1 WHO ladder step, 35 (25.2%) were treated with increased WHO ladder steps (ladder 1-->2 or 2-->3) or reduced WHO ladder steps (ladder 3-->2 or 2-->1). The total response rate for pain relief was 100%: 129 (92.8%) patients had complete relief, 7 (5.0%) had obvious relief, 3(2.2%) had moderate relief. The median time for pain control was 5 days (range, 1-12 days). Sustained release tablets of morphine, transdermal fantanyl, and sustained release tablets of oxycodone were used in 20, 28, and 40 patients, respectively. The median ages of the 3 groups were 10 (5-18), 6 (2.3-16), and 5 (2.5-16) years, respectively. The median of maximum dosages of the 3 single drugs were 20 (10-70) mg, 25 (12.5-50) microg/h, and 10 (5-30) mg, respectively. The median doses used in the 3 groups were 100 (20-360) mg, 5 (1.25-7.5) mg, and 60 (10-200) mg, respectively. The non-steroid anti-inflammatory drug-induced adverse events were nausea and vomiting with very low frequencies. The weak opioid and strong opioid drug-induced adverse events included constipation, nausea, vomiting, and somnolence, all of which were reversible. No severe adverse events, including respiratory depression and drug addiction, happened.
  
  
  CONCLUSIONS
  The WHO ladder approach for cancer pain is appropriate for children. Currently in China, most analgesics for adults could be used for pediatric cancer pain treatment.
authors: State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, PR China.
authors: Zi-Jun
authors: ZJ
authors: Zhen
authors: Xiao-Fei
authors: XF
authors: Sun
authors: Yi
authors: Y
authors: Xia
authors: Jia-Yu
authors: JY
authors: Ling
authors: Lei
authors: L
authors: Zheng
authors: Wen-Biao
authors: WB
authors: Luo
authors: Hui
authors: H
authors: Lin
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000139:chemically induced; D003692:Delayed-Action Preparations; D005240:Feasibility Studies; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007938:Leukemia / Q000150:complications; D008223:Lymphoma / Q000150:complications; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D009325:Nausea / Q000139:chemically induced; D010098:Oxycodone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D014839:Vomiting / Q000139:chemically induced; D014944:World Health Organization
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003692:Delayed-Action Preparations; D009020:Morphine; D010098:Oxycodone; D005283:Fentanyl