The following are areas of priority for future work in pediatric cancer pain.

ASSESSMENT AND METHODOLOGY

1. Research on the description, prevalence, and correlates of pediatric cancer pain.

2. Evaluation of the effects of coursework and workshops about pediatric cancer pain on professional practice.

3. Development and evaluation of the impact of quality assurance programs on the management of pain in childhood cancer.

4. Further refinement and validation of instruments to measure cancer pain in children.

DISEASE-RELATED PAIN

1. Development of more convenient drug delivery systems, including transdermal application.

2. Development of new analgesics which provide relief of intense pain with fewer side effects than opioids that are currently available. In particular, agents that can relieve severe pain but produce less respiratory depression would be extremely useful for infants and patients with diminished respiratory reserve.

3. Development of more effective agents for management of side effects. For example, antiemetics for patients unable to tolerate phenothiazines or butyrophenones, or antipruritics for patients whose itching is refractory to antihistamines.

4. Comparisons of short-acting and long-acting oral analgesics in children.

5. Study of the importance of neuropathic pain in cancer pain in children and comparisons of the various treatments for neuropathic pain, including tricyclics and anticonvulsants.

PROCEDURE-RELATED PAIN

1. Local anesthesia

a. When should local anesthesia be used?

b. What local anesthetics are most effective?

c. Are anesthetic creams effective?

d. What is the feasibility and efficacy of ionophoresis of lidocaine and other local an-esthetic delivery methods, including buffered lidocaine?

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