American Pain Society's 27th Annual Scientific Meeting (May 8 – 10, 2008): Management of Intractable Pain in Children with Life-Limiting Conditions

More than 14,000 children die from life-limiting diseases each year in the USA. Case series suggest the majority of children with advanced cancer receive good pain relief, if providers apply the World Health Organization principles of pain management; less has been reported on the effectiveness of the WHO approach for other pediatric life-limiting diseases. The management of children with intractable pain remains a challenge. Dr. Gibbon will discuss the assessment of non-nociceptive sources of pain and suffering in the setting of a refractory distress. She will review psychotherapeutic interventions, including cognitive-behavioral interventions, as well as integrative treatments modalities. Dr. Berde will summarize recent research related to the age-dependence of opioid tolerance and opioid induced hyperalgesia. He will relate these mechanisms to clinical situations involving poor responses to opioid dose escalation. He will review adjuvant analgesics and antihyperalgesic agents, and the potential uses and limitations of spinal drug delivery systems, and other interventional approaches. Dr. Friedrichsdorf will discuss practical considerations of low-dose ketamine application. He will then review sedation to unconsciousness in the rare circumstance that a child’s pain is truly refractory. Pharmacological approaches and ethical considerations providing different levels of sedation, from mild to complete, will be evaluated.