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Pain control in children and young people with cancer
This Month in
THE JOURNAL OF
PEDIATRICS January 2008 • Volume 152 • Number 1 Copyright © 2008 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Pain control in children and young people with cancer Few data exist that provide an evidence base for choosing among drugs and dosages for management of pain in children with cancer. In this issue of The Journal, Hewitt et al report results of a prospective survey of opioid use in palliative care of patients 0-19 years old with cancer in 22 oncology centers in the United Kingdom. A questionnaire was performed monthly for 6 months or until death in 185 individuals. Professionals collected information on drug use and level of pain. Multiple opioid preparations and routes of administration were used, and maximum dosages were highly variable, ranging from oral morphine equivalent of 0.09 to 1500 mg/kg/24 hours. Children with solid tumors outside the central nervous system were more likely than others to receive multiple opioids and higher doses, and still had pain as a major problem. The data provide a first step in an evidence-based approach to pain management in palliative care. As the authors point out, however, evidence-based management of pain should also be an integral part of curative care for children and young people with cancer. An accompanying editorial by Baker puts the problem of pain control and strategies for management in perspective.
—Sarah S. Long, MD page 39 (article) page 6 (editorial)
Bullies and their victims The enormous impact of bullying in schools has become a topic of broad public discussion. Scholarship on the topic, however, has been slow to develop. This issue of The Journal features a provocative study by a group in Seattle, examining the association between bullying and school problems. The study addressed three groups: bullies, victims of bullies, and children who were both. A couple of points are of particular interest in this study. First of all, over a quarter of the children studied in this urban public school fell into one of these three groups. This is clearly a problem of very high prevalence. Secondly, the identified school problems were present in all three groups; being “sad most days,” for example, was a concern for the bullies themselves as well as for their victims. In light of some recent high-profile incidents, the observation that victims were more likely to believe that carrying a gun to school was acceptable is noteworthy.
—Thomas R. Welch, MD page 123 (article)
Body shape in children and adolescents With the epidemic of obesity, there has been concern about assessment of adiposity and different deposits of fat which may lead to different body shapes. Frequently, we think of body mass index (BMI) as the best way to characterize the development of obesity in the clinical setting. However, BMI is not a perfect measure of adiposity and may be imprecise. In this issue of The Journal, Lebiedowska et al report on the development of a human body shape index based on normal age related changes in body shape in boys and girls. They found that this index had less inherent variability and was less influenced by growth than other widely used indices. It remains to be determined what method will be best to determine obesity in children in the clinical setting. The method chosen must be easily usable by primary care pediatricians in a busy clinical practice.
—Stephen R. Daniels, MD, PhD page 45 (article)
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
January 2008
A1
THE JOURNAL OF
PEDIATRICS January 2008 • Volume 152 • Number 1 Copyright © 2008 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Pain control in children and young people with cancer Few data exist that provide an evidence base for choosing among drugs and dosages for management of pain in children with cancer. In this issue of The Journal, Hewitt et al report results of a prospective survey of opioid use in palliative care of patients 0-19 years old with cancer in 22 oncology centers in the United Kingdom. A questionnaire was performed monthly for 6 months or until death in 185 individuals. Professionals collected information on drug use and level of pain. Multiple opioid preparations and routes of administration were used, and maximum dosages were highly variable, ranging from oral morphine equivalent of 0.09 to 1500 mg/kg/24 hours. Children with solid tumors outside the central nervous system were more likely than others to receive multiple opioids and higher doses, and still had pain as a major problem. The data provide a first step in an evidence-based approach to pain management in palliative care. As the authors point out, however, evidence-based management of pain should also be an integral part of curative care for children and young people with cancer. An accompanying editorial by Baker puts the problem of pain control and strategies for management in perspective.
—Sarah S. Long, MD page 39 (article) page 6 (editorial)
Bullies and their victims The enormous impact of bullying in schools has become a topic of broad public discussion. Scholarship on the topic, however, has been slow to develop. This issue of The Journal features a provocative study by a group in Seattle, examining the association between bullying and school problems. The study addressed three groups: bullies, victims of bullies, and children who were both. A couple of points are of particular interest in this study. First of all, over a quarter of the children studied in this urban public school fell into one of these three groups. This is clearly a problem of very high prevalence. Secondly, the identified school problems were present in all three groups; being “sad most days,” for example, was a concern for the bullies themselves as well as for their victims. In light of some recent high-profile incidents, the observation that victims were more likely to believe that carrying a gun to school was acceptable is noteworthy.
—Thomas R. Welch, MD page 123 (article)
Body shape in children and adolescents With the epidemic of obesity, there has been concern about assessment of adiposity and different deposits of fat which may lead to different body shapes. Frequently, we think of body mass index (BMI) as the best way to characterize the development of obesity in the clinical setting. However, BMI is not a perfect measure of adiposity and may be imprecise. In this issue of The Journal, Lebiedowska et al report on the development of a human body shape index based on normal age related changes in body shape in boys and girls. They found that this index had less inherent variability and was less influenced by growth than other widely used indices. It remains to be determined what method will be best to determine obesity in children in the clinical setting. The method chosen must be easily usable by primary care pediatricians in a busy clinical practice.
—Stephen R. Daniels, MD, PhD page 45 (article)
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
January 2008
A1