Mucositis Pain Oncology-Specifi c Pain

malignancy; surgical procedures including tumor resection, central venous catheter placement, lumbar puncture and bone marrow aspirate biopsy; and as side effects from chemotherapy including specifi c drug effects such as vincristine- associated neuropathy and general effects such as oral mucositis. Appropriate assessment of pain is the vital fi rst step in appropriate pain manage- ment. Patients who are assessed as having pain should be treated according to the WHO pain lad- der with the appropriate analgesic chosen based on the level of pain, expected course of pain, as well as with consideration to the individual patient’s pain history. Appropriate pain manage- ment requires frequent reassessment to determine if pain control is adequate and side effects are tolerable. The pediatric oncology practitioner must also be aware of the potential for develop- ment of refractory pain or neuropathic pain not well controlled with the use of opioids. In these situations, an interdisciplinary team approach is ideal, utilizing the expertise of a pain service if available as well as alternative and complemen- tary therapies to assist in treatment of the pain experience. Generally, recommendations for pain control are based on expert opinion and consen- sus guidelines, as fi rm evidence is lacking in pediatric patients. References Akbayram S, Akgun C, Dogan M et al 2010 Use of pyri- doxine and pyridostigmine in children with vincristine- induced neuropathy. Indian J Pediatr 77:681–683 Alimi D, Rubino C, Pichard-Leandri E et al 2003 Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol 21:4120–4126 Anderson BJ 2013 Is it farewell to codeine? Arch Dis Child 98:986–988 Anghelescu DL, Faughnan LG, Baker JN et al 2010 Use of epidural and peripheral nerve blocks at the end of life in children and young adults with cancer: the col- laboration between a pain service and a palliative care service. Paediatr Anaesth 20:1070–1077 Anghelescu DL, Faughnan LG, Jeha S et al 2011 Neuropathic pain during treatment for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 57:1147–1153 Anghelescu DL, Faughman LG, Popenhagen MP et al 2014 Neuropathic pain referrals to a multidisci- plinary pediatric cancer pain service. Pain Manag Nurs 15:126–131 Apiliogullari S, Duman A, Gok F et al 2010 Spinal nee- dle design and size affect the incidence of postdural puncture headache in children. Paediatr Anaesth 20:177–182 Babbar S, Marier JF, Mouksassi MS et al 2009 Pharmacokinetic analysis of capsaicin after topical administration of a high-concentration capsaicin patch to patients with peripheral neuropathic pain. Ther Drug Monit 31:502–510 Baron R, Binder A, Wasner G 2010 Neuropathic pain: diagnosis, pathophysiological mechanisms, and treat- ment. Lancet Neurol 9:807–819 Basurto Ona X, Martinez Garcia L, Sola I et al 2011 Drug therapy for treating post-dural puncture head- ache. Cochrane Database Syst Rev 8:CD007887 Berde CB, Lehn BM, Yee JD et al 1991 Patient- controlled analgesia in children and adolescents: a randomized, prospective comparison with intramus- cular administration of morphine for postoperative analgesia. J Pediatr 118:460–466 Berde CB, Sethna NF 2002 Analgesics for the treatment of pain in children. N Engl J Med 347:1094–1103 Blanchard E, Schwarz S 1988 Clinically signifi cant changes in behavioral medicine. Behav Assess 10:171–188 Bruera E, Neumann CM 1999 Respective limits of pal- liative care and oncology in the supportive care of can- cer patients. Support Care Cancer 7:321–327 Buck M 2002 Paediatric use of gabapentin. Pediatr Pharmacother 8:1–4 Camann WR, Murray RS, Mushlin PS et al 1990 Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg 70:181–184 Candy B, Jones L, Goodman ML et al 2011 Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Cochrane Database Syst Rev 1:CD003448 Cepeda MS, Alvarez H, Morales O, Carr DB 2004 Addition of ultralow dose naloxone to postoperative morphine PCA: unchanged analgesia and opioid requirement but decreased incidence of opioid side effects. Pain 107:41–46 Chaparro LE, Wiffen PJ, Moore RA et al 2012 Combination pharmacotherapy for the treatment of neuropathic pain in adults. Cochrane Database Syst Rev 7:CD008943 Cherny N, Ripamonti C, Pereira J et al 2001 Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol 19:2542–2554 Cheville AL, Sloan JA, Northfelt DW et al 2009 Use of a lidocaine patch in the management of postsurgical neuropathic pain in patients with cancer: a phase III double-blind crossover study N01CB. Support Care Cancer 17:451–460 Chong MS, Bajwa ZH 2003 Diagnosis and treatment of neuropathic pain. J Pain Symptom Manage 25: S4–S11