title: Management of pain in leukemic children using the WHO analgesic ladder.
abstract: OBJECTIVE
  To ascertain the effectiveness of WHO analgesic ladder in pain management in children with leukemia.
  
  
  METHODS
  Children with leukemia who were referred to a pain and palliative care clinic attached to the Department of Pediatrics of a medical teaching hospital during a period of 6 months were included in the study.
  
  
  RESULTS
  Thirty nine (39) children, who constituted 64% of children on treatment for leukemia, required referral to pain and palliative care services during the study period. Of these 92% had Acute Lymphocytic Leukemia (ALL) and 8% had Acute Non Lymphocytic Leukemia (ANLL). 95% of children had nociceptive pain and 5% had neuropathic pain. Step - 1 analgesia was effective in 12 (31%) children and 21 (54%) could be managed with Step - 2 analgesia. Step - 3 analgesia was required in only 6 (15%) children. Step 3 analgesia was required in children with neuropathic pain and bone pain.
  
  
  CONCLUSIONS
  WHO analgesic ladder is effective in managing pain in children with leukemia. Majority of cases of cancer pain in children could be managed by the treating physician using non-opioids, weak opioids and adjuvants as per the WHO guidelines. Children with bone pain and neuropathic pain may require referral to specialist services and use of strong opioids like morphine. The study emphasizes the need for establishing specialist pain management services in all centres where children with cancer are treated.
authors.affiliation: Department of Pediatrics, Institute of Maternal and Child Health, Medical College, Calicut, Kerala, India, geetakkumar@gmail.com.
authors.forename: M G
authors.initials: MG
authors.lastname: Geeta
authors.forename: P
authors.initials: P
authors.lastname: Geetha
authors.forename: V T
authors.initials: VT
authors.lastname: Ajithkumar
authors.forename: P
authors.initials: P
authors.lastname: Krishnakumar
authors.forename: K Suresh
authors.initials: KS
authors.lastname: Kumar
authors.forename: Lulu
authors.initials: L
authors.lastname: Mathews
mesh_terms: D000293:Adolescent; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002173:Cancer Care Facilities; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010148:Intractable Pain / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014944:World Health Organization
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid