Pain Management and Children

What are the causes and effects of pain?

Pain management is an important concern for a child with cancer or other pain-causing disease. When a child has cancer, one of their greatest fears, and the fear of parents, is pain. Every effort should be made to ease the pain during the treatment process.

Pain is a sensation of discomfort, distress, or agony. Because pain is unique to each person, a child’s pain can’t be measured with a lab test or imaging study. Healthcare providers can evaluate pain by observing a child and asking about it. There are a number of tools and methods available to help assess pain in children.

Pain may be acute or chronic. Acute pain is severe and lasts a relatively short time. It is usually a sign that body tissue is being injured in some way. The pain generally disappears when the injury heals. Chronic pain may range from mild to severe, and is present to some degree for long periods of time.

Many people believe that if a child has been diagnosed with cancer, they must be in pain. This is not necessarily the case. When pain is present, it can often be reduced or even prevented. Pain management is an important topic to talk about with your child’s doctor as soon as a cancer diagnosis is suspected.

Pain may be the result of the cancer or it may be from other reasons. For example, children can normally have headaches, general discomfort, pains, and muscle strains as part of being a child. Not every pain a child expresses is from the cancer, or is being caused by the cancer.

Cancer pain may depend on the type of cancer, the stage of the disease, and how well your child can tolerate pain.  Cancer pain that lasts several days or longer may result from:

  • Pain from a tumor that is growing, or pain from a tumor that is pressing on body organs, nerves, or bones

  • Poor blood flow because the cancer has blocked blood vessels

  • Blockage of an organ or tube in the body

  • Cancer cells that have spread to other sites in the body (metastasis)

  • Infection or inflammation

  • Side effects from chemotherapy, radiation therapy, or surgery

  • Stiffness from inactivity

  • Psychological responses to illness, such as tension, depression, or anxiety

  • Severe developmental delay, which increases risk for sensory and neuropathic pain

What is pharmacological pain management?

Pharmacological pain management involves the use of medicines to treat the pain. Pediatric oncology clinics usually offer several options for any procedure that may be painful, such as a bone marrow aspiration or lumbar puncture. There are many types of medicines and several methods used in giving them, from very temporary (10-minute) mild sedation, to full general anesthesia in the operating room. Pain medicine is usually given in one of the following ways:

  • By swallowing (orally)

  • By IV (intravenous, through a needle in a vein or marrow in a long bone

  • By a catheter in the back

  • Through a patch on the skin

Examples of pharmacological pain relief include:

  • Mild pain relievers, such as acetaminophen and ibuprofen

  • Opioid medicines, such as morphine and oxycodone

  • Sedation (usually given by IV)

  • General anesthesia 

  • Cream or patches put on the skin to numb the area

  • Adjuvant pain relievers, such as antidepressants or anticonvulsants for nerve pain

  • Steroids to reduce inflammation, such as for an enlarged liver or swelling in the brain

  • Radiation or bisphosphonates for bone pain

Some children build up a tolerance to sedatives and pain medicines. This means that over time, doses may need to increase or the choice of medicines may need to change. Fear of addiction to narcotics is common among families. It is important to understand that the ultimate goals are comfort, function, and overall quality of life, which means taking steps to assure the child is free from pain. There is no evidence of addiction to pain medicines in children being treated for cancer.

What is nonpharmacological pain management?

Nonpharmacological pain management is the management of pain without medicines. This method utilizes ways to alter thinking and focus to decrease pain. Methods include:

  • Psychological. The unexpected is always worse because of what one imagines. If the child is prepared and can anticipate what will happen to them, the child's stress level will be much lower. Ways to do this include:

    • Explaining each step of a procedure in detail, using simple pictures or diagrams when available

    • Meeting with the person who will do the procedure and allowing your child time to ask questions

    • Touring the room where the procedure will take place

    • Watching a video which describes the procedure based on the child’s level of understanding; small children can “play” the procedure on a doll, or watch a “demonstration” on a doll

  • Hypnosis. With hypnosis, a professional (such as a psychologist or doctor) guides the child into an altered state of consciousness that helps the child to focus or narrow their attention to reduce discomfort.

  • Imagery. Guiding a child through an imaginary mental image of sights, sounds, tastes, smells, and feelings can often help shift attention away from the pain. The image is often a pleasant one.

  • Distraction. Distraction can be helpful, particularly for babies, by using colorful, moving objects. Singing songs, telling stories, or looking at books or videos can distract preschoolers. Older children find watching TV or listening to music helpful. Distraction should not be a substitute for explaining what to expect.

  • Relaxation. Children can be guided through relaxation exercises, such as deep breathing and stretching, to reduce discomfort.

Other nonpharmacological pain management may use alternative therapies, such as acupuncture, massage, or biofeedback, to ease discomfort.

Each child experiences pain differently. It’s important to tailor a pain management plan based on each child’s needs. Finding the best plan often requires testing different treatments to see which one works best.