Pain management

What are the causes and effects of pain?

Pain management is an important concern for a child with cancer. When a child has cancer one of the child's greatest fears 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 individual, a child's pain cannot be evaluated by anyone else.

Pain may be acute or chronic. Acute pain is severe and lasts a relatively short time. It is usually a signal that body tissue is being injured in some way, and 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 an individual has been diagnosed with cancer, they must be in pain. This is not necessarily the case, and, when pain is present, it can be reduced or even prevented. Pain management is an important area to discuss with your child's physician as soon as a cancer diagnosis is made or suspected.

Pain may occur as a result of the cancer or for other reasons. Children can normally have headaches, general discomfort, pains and muscle strains as part of being a child. Not everyBpain 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 (extent) of the disease and your child's pain threshold (or tolerance for pain). Cancer pain that lasts several days or longer may result from:

• Pain from a tumor that is enlarging, or pain from a tumor that is pressing on body organs, nerves or bones.
• Poor blood circulation because the cancer has blocked blood vessels.
• Blockage of an organ or tube in the body.
• Metastasis - cancer cells that have spread to other sites in the body.
• Infection or inflammation.
• Side effects from chemotherapy, radiation therapy or surgery.
• Stiffness from inactivity.
• Psychological responses to illness such as tension, depression or anxiety.

Specific treatment for pain will be determined by your child's physician based on:

• Your child's age, overall health and medical history.
• Type of cancer.
• Extent of disease.
• Your child's tolerance for specific medications, procedures or therapies.
• Your opinion or preference.

The two categories of pediatric pain management are pharmacological and non-pharmacological.

What is pharmacological pain management?

Pharmacological pain management for cancer refers to the use of pharmaceutical medications. Pediatric oncology clinics usually offer several pediatric 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.
• By a special catheter in the back.
• Through a patch on the skin.

Examples of pharmacological pain relief for cancer pain in children include the following:

• Analgesics (mild pain relievers).
• Sedation (usually given by IV).
• Anesthesia (usually given by IV).
• Topical anesthetics (cream put on the skin to numb the area).
• Pain relievers.

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 narcotics is common among families. It is important to understand, that the ultimate goal is comfort, 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.

What is non-pharmacological pain management?

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 the following:

• Psychological:

The unexpected is always worse because of what one imagines. If the child is prepared and can anticipate what will happen to them, their 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 physician) guides the child into an altered state of consciousness that helps the child to focus or narrow their 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 discover the best method for pain control for your child prior to the onset of pain.