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Miró J, Solé E, Castarlenas E, Ingelmo P, Nolla MDC, Escribano J, Reinoso-Barbero F. The Treatment of Pediatric Pain in Spain: A Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2484. [PMID: 36767850 PMCID: PMC9915536 DOI: 10.3390/ijerph20032484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Pain is a common experience among children and adolescents, and pain management in this population is a challenge to clinicians. The aims of this study were to increase our understanding of current practices in the management of both acute and chronic pediatric pain in Spain, explore potential barriers to ideal practices, and identify professional needs as perceived by healthcare professionals. A total of 277 healthcare professionals took part, all of whom had wide experience in managing children and adolescents with pain (M [SD] age = 44.85, [10.73]; 75% women). Participants had to respond to a web-based survey with 50 questions related to pain education, organizational characteristics of their pain programs (including the characteristics of the patients treated), and current practices in the assessment and treatment of children and adolescents with pain. Almost all the participants (93%) acknowledged important gaps in their training, and only 47% reported that they had received specific education on the management of pediatric pain during their undergraduate and postgraduate studies. A third (31%) were members of multidisciplinary teams, and almost all (99%) understood that protocols to guide the management of pain in young people were necessary. However, only a few of them used a protocol to assess and treat (56% and 48%, respectively) acute and chronic pain (24% and 23%, respectively). The data also showed that a lack of pain education, coordination of professionals, and guidelines was perceived as an important barrier in the care provided to children and adolescents with pain in Spain. The findings of this study can now be used by healthcare professionals in Spain interested in managing pediatric pain, as well as policymakers concerned to improve the education of professionals and the care given to young people with pain.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Ester Solé
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Pablo Ingelmo
- Department of Anesthesia, McGill University, 1001 Boul. Decarie, Montreal, QC H4A 3J1, Canada
| | - Maria del Carme Nolla
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
- Xarxa Social i Sanitària, 43003 Tarragona, Spain
| | - Joaquín Escribano
- School of Medicine, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain
- Department of Pediatrics, Hospital Universitari Sant Joan, Avgda. Dr. Josep Laporte 2, 43204 Reus, Spain
| | - Francisco Reinoso-Barbero
- Pediatric Anesthesiology Service, Hospital Universitario La Paz, P. Castellana 261, 28046 Madrid, Spain
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Mahmood I. A comparison of different methods for the first-in-pediatric dose selection. J Clin Transl Res 2022; 8:369-381. [PMID: 36518546 PMCID: PMC9741938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND AIM To conduct a pediatric clinical trial, it is important to optimize pediatric dose as accurately as possible. This is mainly because due to ethical reasons, children cannot be given several doses to evaluate pharmacokinetics, safety, and efficacy of a drug. METHODS In this study, several simple methods to project a first-in-pediatric dose to initiate a clinical trial were evaluated. These methods were as follows:(1) Weight-based pediatric dose prediction (allometric scaling), (2) Salisbury rule (weight-based method), and (3) pediatric dose prediction based on predicted clearance. These methods were compared with the dose given to children in clinical practice. The methods were also compared with whole-body physiologically based pharmacokinetic (PBPK) model (n = 11). A ±30% prediction error (predicted vs. observed) was considered acceptable. RESULTS There were 27 drugs with 113 observations (different age groups from preterm neonates to adolescents). At least, ≤30% prediction error in pediatric dose projection was noted for more than 70% observations. The predictive performance of all the proposed methods was comparable with the whole-body PBPK. CONCLUSIONS The proposed methods are simple and accurate and can be developed on a spreadsheet in a very short period of time. RELEVANCE FOR PATIENTS The study provides an estimate of first-in-pediatric dose by simple methods to initiate pediatric clinical trials. Especially, Salisbury rule is based on body weight and is very simple and works fairly well in children >30 kg body weight and can be even used in clinical settings.
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Affiliation(s)
- Iftekhar Mahmood
- Mahmood Clinical Pharmacology Consultancy, LLC, Rockville, Maryland, USA
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Jończyk R, Beuter C, Bulawa B, Buller S, Eibl C, Elling C, Gautrois M, Rengelshausen J, Schmidt C, Thömmes G, Khalil F. Multiple Dose Pharmacokinetics of Tapentadol Oral Solution for the Treatment of Moderate to Severe Acute Pain in Children Aged 2 to. J Pain Res 2022; 15:3103-3114. [PMID: 36203787 PMCID: PMC9531608 DOI: 10.2147/jpr.s364902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Patients and Methods Results Conclusion
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Affiliation(s)
- Renata Jończyk
- Center for Hospital Health Care Services, Clinic of Pediatric Surgery, Subdivision of Pediatric Urology, Rzeszow, Poland
| | | | | | | | | | | | | | | | | | | | - Feras Khalil
- Grünenthal GmbH, Aachen, Germany
- Correspondence: Feras Khalil, Grünenthal GmbH, Zieglerstraße 6, Aachen, 52078, Germany, Tel +49 241 569 3295, Email
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Fuller C, Huang H, Thienprayoon R. Managing Pain and Discomfort in Children with Cancer. Curr Oncol Rep 2022; 24:961-973. [PMID: 35353347 DOI: 10.1007/s11912-022-01277-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Approximately 15,600 children are diagnosed with cancer annually. Many of these children have cancer-related pain that improves with cancer treatment, but some develop intractable pain from cancer progression or sequelae from treatment modalities. The purpose of this paper is to provide a critical evaluation of the literature relevant to pain management in children with cancer. We intend to emphasize important and up-to-date findings in pharmacology, interventional pain management, and complementary and alternative medicine. RECENT FINDINGS Alternative medications and routes of administration, complementary and alternative medicine techniques, and interventional pain procedures offer possible routes for a multi-pronged pediatric cancer pain management plan, although high-level data is often lacking. To improve pediatric cancer pain management, a multifaceted approach embracing the biopsychosocial model of pain is recommended, incorporating evidence-based pharmacology, complementary and alternative medicine techniques, and if needed, interventional pain procedures.
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Affiliation(s)
- Clinton Fuller
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Ste A3300, Houston, TX, USA.
| | - Henry Huang
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Ste A3300, Houston, TX, USA
| | - Rachel Thienprayoon
- Departments of Pediatrics and Anesthesia, Division of Palliative Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Eissa A, Tarau E, Beuter C, Radic T, Watson E, Sohns M, Lefeber C, Hammer GB. Tapentadol for the Treatment of Moderate-to-Severe Acute Pain in Children Under the Age of Two Years. J Pain Res 2021; 14:229-248. [PMID: 33542653 PMCID: PMC7853441 DOI: 10.2147/jpr.s269530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background Pharmacokinetics (PK), efficacy, and safety of the opioid analgesic tapentadol in the treatment of moderate-to-severe acute pain have so far not been investigated in pediatric patients <2 years of age. Patients and Methods Two multicenter, open-label trials assessed the pharmacokinetic profile, safety, tolerability, and efficacy of single doses of tapentadol oral solution (OS; NCT02221674; n=19) or intravenous infusion (IV, EudraCT 2014-002259-24; n=38) in children from birth to <2 years of age. Of these, 8 preterm neonates were included in the IV trial. A third randomized, double-blind, placebo-controlled trial (NCT02081391) investigated the efficacy and safety of multiple tapentadol OS doses in patients from birth to <2 years (placebo n=4, tapentadol n=11) using an immediate rescue trial design. Patients in all three trials underwent surgery that, in the investigator’s opinion, reliably produced moderate-to-severe pain requiring opioid treatment. Results Administration of single tapentadol doses resulted in tapentadol serum concentrations within the targeted range known to be safe and efficacious in adults and compared well to the range observed for children aged 2 to <18 years. Pain intensity already improved 15 min after administration. In the multiple dose trial, amounts of supplemental opioid analgesic medication within the first 24 h after start of trial medication were low (placebo 0.02 mg/kg, tapentadol 0.05 mg/kg). All patients stopped treatment with the trial medication because opioid analgesics were no longer required. Treatment-emergent adverse events occurred in 42.1% (tapentadol OS single dose), 28.9% (tapentadol IV), and 75% of placebo and 54.5% of tapentadol patients (tapentadol OS multiple doses), none of them serious. Conclusion Tapentadol showed a favorable PK and safety profile in children <2 years of age. Multiple tapentadol OS dosing is efficacious and generally well tolerated in children ≥2 years and might also be a useful treatment option for children <2 years in need of strong analgesics.
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Affiliation(s)
- Ayman Eissa
- Anaesthetic Department, Sheffield Children's Hospital, Western Bank, Sheffield, UK
| | - Eva Tarau
- Grünenthal USA Inc., Overland Park, KS, USA
| | | | | | | | | | | | - Gregory B Hammer
- Department of Pediatrics and Anesthesiology, Perioperative and Pain Management, Stanford University School of Medicine, Stanford, CA, USA
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Eerdekens M, Radic T, Sohns M, Khalil F, Bulawa B, Elling C. Outcomes of the Pediatric Development Plan of Tapentadol. J Pain Res 2021; 14:249-261. [PMID: 33542654 PMCID: PMC7853428 DOI: 10.2147/jpr.s290487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
The opioid analgesic tapentadol was the first pain medication to be developed for the treatment of pain in children under a formal process established by the regulatory authorities. This article summarizes the outcomes of the pediatric development program for tapentadol across the entire age range from birth (including neonates) to adolescents <18 years of age. In addition, the challenges experienced when designing and conducting the pediatric tapentadol clinical trials as well as the interactions with the regulatory authorities are discussed. As a first outcome, the oral solution of tapentadol was authorized in the EU in 2018 as a new treatment option in the hospital setting for moderate to severe acute pain in children from 2 to <18 years of age.
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