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DOI: 10.1055/s-0037-1617806
Schmerztherapie in der pädiatrischen Onkologie
Pain management in paediatric oncologyPublication History
Publication Date:
12 January 2018 (online)
Zusammenfassung
Schmerzen begleiten das krebskranke Kind im gesamten Verlauf seiner Erkrankung und stellen nicht selten eine bedeutende Einschränkung der Lebensqualität dar. In den allermeisten Fällen lassen sich auch schwere Schmerzen durch eine rationale Schmerztherapie beherrschen. Unabdingbare Voraussetzung dafür sind eine ausführliche Schmerzanamnese und die kontinuierliche Schmerzmessung und Dokumentation.
Die medikamentöse Schmerzbehandlung erfolgt nach dem WHO-Stufenschema, wobei sich die Notwendigkeit zu Modifikationen ergeben kann. Adjuvante Medikamente und nichtmedikamentöse Therapiemöglichkeiten ergänzen einen umfassenden Therapieansatz. Therapienebenwirkungen müssen antizipiert und behandelt werden.
Besondere Probleme wie Mukositis, neuropathische Schmerzen, Knochenschmerzen und Schmerzen in der Lebensendphase erfordern individuelle und flexible Therapieansätze.
Eine unzureichende Schmerztherapie gründet meist in verzögertem Beginn, zu niedrigen Dosierungen, fehlender Titration am Schmerz, d. h. zu zögerlicher Dosissteigerung besonders bei starken Schmerzen.
Summary
Pain accompanies a child with cancer during the whole course of his or her disease and it often causes a major loss of quality of life for the child. With very few exceptions an effective pain management can control severe pain. Taking the pain history, continuous pain assessment and documentation are major hallmarks to achieve this.
The optimal drug pain relief therapy follows the WHO-three-step analgesic ladder with possible modifications in individual cases. Adjuvant drugs and non-drug pain management add up to a comprehensive base of pain relief therapy. Side effects should be anticipated and treated. Particular problems such as mucositis, neuropathic pain, bone pain or pain in the end-of-life-period need individual and flexible management. An inadequate pain management is usually caused by delaying the initiation of pain relief therapy, insufficient dosage, and insufficient titration, i. e. inadequate increment of dosage especially in case of severe pain.
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