Cancer in Children: Managing Pain
Children coping with cancer usually need help with controlling their pain. Your child’s healthcare provider will assess your child’s pain and prescribe pain medicine as needed. But you are the expert on your child. Your input is important to help the team understand how your child is feeling. Alert your child’s healthcare team if you notice any signs of pain in your child. Also, keep in mind that pain should be treated promptly. This is because untreated pain can cause more stress that can lead to health problems.
Causes of cancer pain
Pain from a tumor. A tumor can cause pain in the area of the body where it is located. A tumor that’s growing and pressing on nearby tissue can also cause pain. This pain can be deep and constant.
Pain due to treatment. Chemotherapy, radiation therapy, and surgery can cause pain. For instance, chemotherapy can cause painful side effects, such as mouth sores.
How pain is assessed in children
The way that children show that they are in pain is different from how adults show pain. Changes in your child’s physical and emotional behavior are also clues about your child’s pain level. A special scale may be used to help your child describe his or her pain. The scale may have facial expressions or numbers. Your child points to the face or number that describes the amount of pain he or she is having.
Pain medications your child may receive
There are many different pain medicines that can be used. The type your child receives depends on the cause of the pain and the results of the pain assessment. Your child’s age and health history are also factors. Some types of pain medicines include:
Opioids to reduce moderate to severe pain. These medicines are also called narcotics, and must be prescribed by the doctor, nurse practitioner or physicians's assistant.
Non-opiods to reduce pain. These medicines are not narcotics but still require a prescription.
Anticonvulsants or antidepressants to manage pain that results from irritated nerves. These medicines are most often used to treat seizures and depression, but they can also calm nerves to ease pain.
Over-the-counter (OTC) medicines to reduce mild to moderate pain and fever. Note: Do not give your child OTC medicines , such as aspirin, ibuprofen, or acetaminophen, unless you are told to do so by your child’s healthcare provider. These medicines can cover up a fever, which is an important sign that there is a problem with your child’s health. They can also make it harder for the blood to clot. This raises your child’s risk of bleeding.
Keep in mind that a medicine can have different names. So ask your healthcare team if you don’t recognize the name of a medicine that’s given to your child and you want to know more.
How pain medicines are given
Pain medicines may be given in different ways.
Pills or liquid. These are taken by mouth or swallowed.
Transdermal patch. This is a patch that is placed on the skin. The pain medicine goes through the skin where it is absorbed into the body.
Intravenous (IV) delivery. A small tube called an IV is placed into a vein in the body to give pain medicines.
PCA (patient-controlled analgesia) pump. A PCA pump uses an IV to give medicines. Your child can press a button and get more medicine when he or she needs it. The medicine helps relieve the pain but it can make your child sleepy. Note: There is a lock out feature with specific settings to protect your child from getting too much of the medicine if he or she presses the button too often.
Regional anesthesia. This is pain medicine that is given to block pain in one part of the body. For instance, an epidural or spinal may be given to numb the body from the waist down.
Possible side effects
Pain medicine may cause side effects. Side effects can include:
Problems with urinating (child can't urinate)
Child can’t urinate
Nausea and vomiting
Euphoria (child feels extreme happiness for a short time)
Hallucination (child sees things that aren’t there)
These usually go away when your child stops taking the medicine.
Safe medicine use
You may worry about your child becoming addicted to pain medicine. This is not very likely because medicines are given in controlled amounts over a set time. You may also be concerned about the risks of taking certain medicines together. Be sure to tell your child’s healthcare provider about all medicines your child takes. This includes OTC products, such as vitamins and herbal supplements. As always, share all of your questions and concerns with your child’s healthcare provider.
Other ways to manage pain
Along with medicine, your child’s pain may be managed in the following ways:
Touch and massage to soothe the child. Rocking and cuddling can also help calm your child.
Comfort sucking to soothe infants and toddlers. Allowing your toddler to suck his or her thumb or using a pacifier for babies 12 months of age and younger can help.
Distraction to take your child’s mind off of pain. Have your child blow bubbles, watch funny videos, and play with toys or games. Your child may also like listening to music, reading and being read to, and doing arts and crafts. A technique called guided imagery can also help. The child thinks about a pleasant or happy scene. Then your child focuses his or her attention on the scene’s sites, smells, and sensations instead of on the pain.
Relaxation techniques, such as deep breathing, to help your child relax. Relaxing helps loosen muscles, ease anxiety, reduce pain, and relieve nausea.
Preparation to get your child ready for painful medical procedures. When your child knows what to expect, then he or she can relax. And when you child is relaxed, the pain may seem easier to bear.
Positive thinking to help your child put a positive spin on his or her pain. Rather than saying “I’m in terrible pain,” saying “I’m working with my doctor so that I’ll feel better” is more positive and helps the child feel in control.
Acupressure to stimulate certain areas of the body called acupoints. Massaging these points releases chemicals that may help reduce pain.
Acupuncture to stimulate certain areas of the body called acupoints by using small needles. But remember that acupuncture may not be right for all kids.
Biofeedback to teach your child how to control certain body functions, such as body temperature, heart rate, and muscle tension. It uses monitoring equipment and electrodes to teach the child how to control these functions. Biofeedback can help reduce pain and give your child a sense of control over his or her pain.
Hypnosis to help your child change how he or she thinks of pain. This is done with the help of a trained practitioner. Hypnosis can reduce pain and pain-related anxiety in your child.
Tips to help manage your child’s pain
Learn what you can about your child’s cancer. Being well informed can reduce some of your own anxiety and help you feel better able to handle the situation. This is important because your child picks up on your fears and worries. By being calm, you can help relieve some of your child’s anxieties and discomfort.
Tell your child’s healthcare providers about any signs of pain that you notice in your child. You may be able to tell from your child’s expressions if he or she is in pain. Your child may also become irritable, moody, cry more often, lose his or her appetite, or become withdrawn. You are most likely to know if these changes in your child’s behavior suggest a problem.
Be honest with your child if you know a medical procedure will cause pain. Ask your healthcare team to help you explain the procedure to your child and answer his or her questions. Reassure your child that you’ll be with him or her or nearby during the procedure.
If your child is in pain, try touching and holding him or her. Stroke your child’s hair or head or hold his or her hand. Play games, watch videos, or read books with your child. If your child has to go to the hospital or clinic, bring comfort items from home. Relaxation techniques, such as blowing bubbles, listening to music, as well as slow and deep breathing, can also help.
Ask your child’s healthcare provider for more information about managing pain in children.
June 28, 2018
Assessment of Cancer Pain, UpToDate., Evaluation and Management of Pain in Children, UpToDate., Overview of Cancer Pain Syndromes, UpToDate.
Levy, Adam, S., MD,Sather, Rita, RN