Opioids, such as morphine and its derivatives, have been shown to clearly reduce pain and improve quality of life in adults. However, little is known about the pain experience and the safety and efficacy of this class of analgesics in children. Until recently, children were thought to feel pain to a lesser degree and have a higher risk of addiction than adults. Newer information indicates that not only do children experience severe pain and are no more at risk for addiction than adults, but they are also at greater risk for psychological disturbances that have immediate and long-term developmental impact. However, children may not readily accept the methods of delivery of most opioids - that is, injection or pill.
Julia C. Finkel, M.D. of the Children's National Medical Center in Washington, D.C. and international colleagues examined 173 children from ages 2 to 16 years, many of whom were cancer patients and who had a history of chronic severe pain and prior oral opioid use. They were transitioned to the fentanyl patch adjusted to equal the concentration of previous oral doses and followed for 15 days.
The researchers found that subjective pain and quality of life improved significantly. By Day 16 the average daily pain intensity score decreased. Many patients elected to continue in the study for three months. After one month, quality of life scores improved. At the end of three months, average play performance scores also showed significant improvement. There were no more adverse experiences than reported in adults and no adverse experiences specific for the pediatric population.
The authors write: "Results from global measurements of pain treatment, safety and quality of life indicate that transdermal fentanyl is an acceptable alternative to oral opioid therapy in children." An opioid patch, such as fentanyl, "is especially useful for good pain management in children with life-threatening conditions in which oral or injectable routes of drug delivery are difficult to administer or add further distress."
Article: "Transdermal Fentanyl in the Management of Children with Chronic Severe Pain: Results from an International Study," Julia C. Finkel, Allen Finley, Christine Greco, Steve J. Weisman, Lonnie Zeltzer, CANCER; Published Online: November 14, 2005 (DOI: 10.1002/cncr.21497); Print Issue Date: December 15, 2005.