Pediatric Pain Management for Cancer

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

• Orally (by swallowing)
• Intravenously (IV), through a needle in a vein or marrow in a long bone
• By a special catheter in the back
• Through a patch on the skin

Examples of pharmacological pain relief include the following:

• Mild pain relievers, such as acetaminophen and ibuprofen
• Opioid analgesics, such as morphine and oxycodone
• Sedation (usually given by IV)
• General anesthesia
• Topical anesthetics (cream or patches put on the skin to numb the area)

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

Non-pharmacological pain management is the management of pain without medications. 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 him or her, his or her stress level will be much lower. Ways to accomplish this include:
  • Explain each step of a procedure in detail, utilizing simple pictures or diagrams when available.
  • Meet with the person who will perform the procedure and allow your child to ask questions ahead of time.
  • Tour the room where the procedure will take place.
  • Adolescents may observe a videotape, which describes the procedure, while small children can "play" the procedure on a doll, or observe 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 him or her to focus or narrow his or her attention, in order 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.
• 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 non-pharmacological pain management may utilize alternative therapies, such as acupuncture, massage or biofeedback, to eliminate discomfort.

Each child experiences pain differently. It is important to tailor a pain treatment plan based on each child’s needs. Finding the best plan often requires testing a variety of treatments by trial and error.