Rapid increase of morphine and benzodiazepine usage in the last three days of life in children with cancer is related to neuropathic pain

Objective To test the hypothesis that children with terminal cancer and neuropathic pain require rapid increases of opioids and benzodiazepines immediately before death, we compared drug usage in the last 72 hours of life in children with and without neuropathic pain. Patients and methods Through the use of retrospective case analysis, pediatric patients with terminal cancer were divided into two groups: one with and one without neuropathic pain. Opioid and benzodiazepine dosages were recorded during the last 3 days of life. Results Eighteen patients were identified: 12 with neuropathic pain and 6 without neuropathic pain. In the neuropathic group, the average dose of morphine 72 hours before death was 231 mg/kg per day and increased to 380 mg/kg per day on the day of death (P =.009). The average benzodiazepine dosage 72 hours before death was 6.0 mg/kg per day and increased to 25.0 mg/kg per day on the day of death (P =.018). In the nonneuropathic pain group, the average dose of morphine and benzodiazepine 72 hours before death was 3.0 mg/kg per day and 0.08 mg/kg per day, respectively, and did not increase substantially on the day of death. Conclusions Dying children with cancer and neuropathic pain have higher baseline requirements of morphine and benzodiazepines and require rapid increases of both drugs in the last 72 hours of life than dying children without neuropathic pain. (J Pediatr 2003;142:373-6)