title: [Use of opioids in palliative care of children with advanced cancer].
abstract: BACKGROUND
  Despite advances in the treatment of cancer in paediatric patients, 15% of children die from the illness progression in Chile, and pain is the most significant symptom in advanced stages. Although the World Health Organization guidelines demonstrate that opioids are fundamental in pain management, there is still resistance to their use. The main objective of this article was to describe the experience in the use of opioids for pain management in paediatric patients with advanced cancer in palliative care (PC).
  
  
  METHODS
  Retrospective study of patients admitted into the PC Program at the Hospital Roberto del Río between 2002 and 2013. Analysis was carried out on demographic data; oncological diagnosis; pain intensity on admission and discharge, according to validated scales; use of non-steroidal anti-inflammatory drugs; weak opioids; strong opioids; adjuvants drugs; the presence of secondary effects resulting from the use of morphine, and the need for palliative sedation.
  
  
  RESULTS
  Of the 99 medical records analysed, the median age was 8 years, 64.6% were male, and there was a similar distribution in three oncological diagnosis groups. Upon admission, 43.4% presented intense to severe pain, and upon discharge there were four patients, but with a maximum VAS score of 7 in only one case. Of the 66 patients taking strong opioids, 89% required less than 0.5mg/kg/hr. Constipation was the most frequently observed secondary effect.
  
  
  CONCLUSIONS
  Two thirds of the patients studied required strong opioids, with which adequate pain management was achieved, with no serious complications observed. The use of opioids in this group of patients, following a protocol, is considered effective and safe.
authors.affiliation: Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile.
authors.forename: Belem
authors.initials: B
authors.lastname: Fernández Urtubia
authors.affiliation: Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile.
authors.forename: Antonella
authors.initials: A
authors.lastname: Trevigno Bravo
authors.affiliation: Unidad de Hemato-Oncología, Hospital de Niños Dr. Roberto del Río, Santiago, Chile; Departamento de Pediatría y Cirugía Infantil, Campus Norte, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Electronic address: natalie.rodriguez@redsalud.gov.cl.
authors.forename: Natalie
authors.initials: N
authors.lastname: Rodríguez Zamora
authors.affiliation: Unidad de Hemato-Oncología, Hospital de Niños Dr. Roberto del Río, Santiago, Chile.
authors.forename: Chery
authors.initials: C
authors.lastname: Palma Torres
authors.affiliation: Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile.
authors.forename: Luis
authors.initials: L
authors.lastname: Cid Barria
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002677:Chile; D003248:Constipation / Q000139:chemically induced / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use; D009369:Neoplasms / Q000473:pathology*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Cancer; Cuidados paliativos; Cáncer; Dolor; Morfina; Morphine; Neoplasmas; Neoplasms; Opioids; Opiáceos; Pain; Palliative care