Pain Management

Author:  Maria Yiallouros, Editor:  Maria Yiallouros, Reviewer:  Prof. Dr. med. Dr. h.c. Günter Henze, English Translation:  Hannah McRae, Last modification: 2020/05/15 https://kinderkrebsinfo.de/doi/e67771

Nearly all children and teenagers with cancer suffer pain. The origin of pain can be both the disease and the treatment. The degree and duration of pain varies depending on the patient's individual situation.

When can pain occur?

Pain can be caused by the cancer itself. For example, most brain tumors are associated with headaches. However, pain can also occur as a result of diagnostics or treatment, respectively, particularly as a side effect of a bone marrow puncture, which sometimes leads to local pain for a short while after the procedure. Also both chemotherapy and radiation can be associated with different side effects that may be painful, such as severe mouth sores, headaches and skin reactions after radiation, and infections. Even after successful treatment, children and adolescents may still experience pain as a late effect of therapy.

Pain is a major problem for cancer patients.

How is the intensity of pain determined?

The assessment of pain can be quite challenging, but it is essential for successful pain management. In order to appropriately and comprehensively determine the type of pain in a child or teenager, the doctors usually use age-related measurement methods.

Infants and young children cannot specify pain, but they exhibit certain behaviors that express the level of pain they are experiencing. For example, screaming and crying, restlessness, insomnia, grimacing, decreased appetite and reduced interest in playing are ways to express pain, and thus relevant observations for a pain assessment.

Older children are able to verbally express the location, intensity, and frequency of the pain they are experiencing. So-called pain questionnaires have proven to help children, teenagers, and/or their parents characterize the severity of symptoms by referencing specific pain scales.

How is pain treated in pediatric oncology?

The type of pain treatment varies depending on the situation. In pediatric Oncology, pain is treated mostly with drugs (pharmacological pain therapy). However, there are additional ways to control pain which do not require medication.

Pharmacological Pain Treatment

Current pain management includes pain medication (analgesics) that can be taken as pills or received intravenously. The doctors chose the type of pain medication based on a patient's type, cause, and severity of the pain. Sometimes painkillers used to treat head or toothaches, such as acetaminophen, are sufficient. But during certain intensive phases of the cancer therapy, stronger medication is often needed to reduce pain that is caused by side effects of chemotherapy.

Opiates such as morphine are successfully used to control severe pain during intensive chemotherapy. In order to prevent physical addiction to those painkillers, special pumps are used. These pumps contain the pain medication, which the patient receives through an intravenous line by pushing a button whenever he or she is in pain. The doctors individually program these devices according to the patient's situation and treatment, thereby determining the dosage and frequency of administration so that the pain is under control but the patient not at risk of addiction.

Additional Methods of Pain Management

In addition to pain medication, various other methods are employed to reduce pain. These include:

• behavioural techniques (such as breathing techniques and muscle relaxation)
• cognitive methods (for example distraction from pain through music or games, hypnosis, comfort and support)
• physical methods (for example touches like stroking, holding, massaging, and weighing). The presence of loved ones and familiar people plays an important role in pain reduction.

Non-pharmacological therapy is an integral part of the entire treatment for children and teenagers with cancer.