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.