Practice of pain control in paediatric oncology - recommendations of the quality-monitoring group of the German Society for Paediatric Oncology and Haematology (GPOH)

In paediatric oncology, optimal pain control is still a challenge. A struct ured pain history and the regular scoring of pain intensity using age-adapt ed measuring tools are hallmarks of optimal pain control. Psychological mea sures are as important as drug therapy in prophylaxis or control of pain, e specially when performing invasive procedures. Pain control is oriented on the WHO multistep therapeutic schedule. On no account must the paediatric p atient have to climb up the 'analgesic ladder' - strong pain requires the p rimary use of strong drugs. Give opioids preferable by the oral route and b y the clock - short acting opioids should be used to treat break-through pa in. Alternatives are IV infusion and patient-controlled analgesia. Constipa tion is the adverse effect most often seen with (oral) opioid therapy. Adve rse effects should be anticipated, and prophylactic treatment should be giv en consistently. The assistance of paediatric nurses is of utmost importanc e in paediatric pain control. Nurses deliver the basis for rational and eff ective pain control by scoring pain intensity and documenting drug administ ration as well as adverse effects. The nurses' task is also to prepare the patient for and monitor the patient during painful procedures. It is the re sponsibility of both nurse and doctor to guarantee emergency intervention d uring sedation whenever needed. In our paper we comment on drug selection a nd dosage, pain measurement tools, and documentation tools for the purpose of pain control. Those tools may be easily integrated into daily routine.