Opioid Therapy for Pediatric Cancer Pain

Abstract

A child with cancer may experience emotional, spiritual, mental, relational, and physical pain during the course of cancer therapy. As pediatric cancer pain is multifaceted, a well-tailored and personalized analgesic regimen is paramount to the treatment of the “whole” of pain. This regimen is likely to rely on opioids; nevertheless, nonopioid and nonpharmacologic strategies should be employed to minimize negative effects of opioids while maximizing comfort. Opioids may induce opioid-induced hyperalgesia, tolerance, and central sensitization, which can all reduce analgesic efficacy. Further, there are concerns regarding the potential impact of opioid therapy on cancer outcomes, such as metastases, recurrence and survival rates, and the substantial risk of opioid misuse among cancer survivors. While there may be no greater indication for opioid therapy than pediatric cancer pain, optimal cancer pain management should rely on multiple approaches including nonpharmacological interventions and medications targeting various receptors and mechanisms for analgesia, nonopioid and opioid.