Bisphosphonate Use in Pediatric Oncology for Pain Management.
Doralina L Anghelescu, Varayini Pankayatselvan, Rosa Nguyen and 5 others
PMID 30114925WHAT IT FOUND
Intravenous bisphosphonates did not significantly reduce pain scores in children with cancer, though opioid consumption dropped at several time points.
The authors suggest high baseline opioid doses or late administration may have masked any analgesic benefit.
Key findings
01Mean pain scores decreased from 2.45 to 0.75 after bisphosphonate administration, but this change was not statistically significant (P = 0.25).
02Opioid consumption did not significantly change overall (P = 0.07), but was significantly decreased at specific time points including Days 4–8, 11–12, and Week 3.
03Bisphosphonates were typically administered late in the disease course, with a median of 80 days from first dose to death, potentially limiting their effectiveness.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective and relied on data from outpatients, which limited the availability of consistent pain scores and medication records. The sample size was small (35 patients) and all participants had terminal disease, restricting generalizability to other pediatric oncology populations. The authors did not account for other variables influencing pain, such as radiation therapy, steroids, NSAIDs, or psychological support. Bisphosphonates were administered very late in the disease course (median 80 days before death), which may have obscured any potential analgesic benefit. High concurrent opioid doses (up to 178 mg/kg per day morphine equivalent) may have masked the specific effect of the bisphosphonates.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that bisphosphonates are ineffective for pediatric cancer pain based on this null primary outcome. The lack of significant pain score reduction may be due to the extremely late stage of administration and the confounding effect of very high opioid doses, rather than a true lack of biological efficacy.