Cancer in Children: Managing Pain

Children with cancer often need help controlling their pain. Your child’s healthcare provider will assess your child’s pain and prescribe pain medicine as needed. You know your child better than anyone. 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 quickly. Untreated pain may be harder to control and may cause more stress that can lead to other 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 into and pressing on nearby tissue and nerves can also cause pain. This pain can feel dull, deep and constant. Or it can feel sharp, shooting, and intermittent.

• Pain due to treatment. Chemotherapy (chemo), radiation therapy, and surgery can cause pain. For example, chemo can cause painful side effects, such as mouth sores. Procedures and tests can also cause pain, such as needle sticks.

How pain is assessed in children

The way that children show that they are in pain can be different from how adults show pain. Changes in your child’s physical and emotional behavior are also clues about your child’s pain level. There may be sounds or words your child uses to express pain. A special rating system may be used to help your child describe their pain. The scale may have facial expressions or numbers. Your child points to the face or number that describes the amount of pain they are having.

Pain medicines your child may receive

There are many different pain medicines that can be used. The type your child gets 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. These reduce moderate to severe pain. These medicines are closely monitored and given in controlled amounts. They must be prescribed by their healthcare provider.

• Non-opioids. These are used to reduce pain. These medicines include acetaminophen non-steroidal non-inflammatory drugs (NSAIDs) like ibuprofen, and steroids. Some are over-the-counter medicines, but require a prescription.

• Anticonvulsants or antidepressants. These are used to manage pain that results from irritated nerves. These medicines are most often used to treat seizures and depression. They can also calm nerves to ease pain.

• Over-the-counter (OTC) medicines. These are used to reduce mild to moderate pain and fever. Note: Don't 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 or pharmacist if you don’t recognize the name of a medicine that’s given to your child.

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 and is absorbed into the body.

• IV (intravenous) 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. If your child is old enough to understand how to use the medicine pump button, they can press it to get more medicine when they need 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 they press the button too often .

• Regional anesthesia. This is pain medicine that is given to block pain in 1 part of the body. For example, an epidural or spinal injection may be given to numb the body from the waist down.

Possible side effects

Pain medicine may cause side effects. Side effects can include:

• Constipation

• Sleepiness

• Itching

• Restlessness

• Problems with urinating (child can't urinate)

• Nausea and vomiting

• Euphoria (child feels extreme happiness for a short time)

• Hallucination (child sees things that aren’t there)

• Allergic reaction

• Dry mouth

• Trouble thinking clearly

• Low blood pressure

These often go away when your child stops taking the medicine.

Safe medicine to use

You may worry about your child becoming dependent or addicted to opioid 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. Tell your child’s healthcare provider about all medicines your child takes. This includes OTC products, such as vitamins and herbal supplements. Share all of your questions and concerns with your child’s provider.

Other ways to manage pain

Help take your child’s mind off of his pain by reading or doing other fun activities.

Along with medicine, your child’s pain may be managed in the following ways:

• Touch and massage. This helps to soothe your child. Rocking and cuddling can also help calm your child.

• Comfort sucking. This helps to soothe infants and toddlers. Letting your toddler suck their thumb or using a pacifier for babies 12 months of age and younger can help.

• Distraction. This helps 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 doing arts and crafts. A technique called guided imagery can also help. Your child thinks about a pleasant or happy scene. Then they focus their attention on the scene’s sights, smells, and sensations instead of on the pain.

• Relaxation techniques. Methods such as deep breathing can help your child relax. Relaxing helps loosen muscles and ease anxiety. It can also reduce pain, and relieve nausea.

• Preparation. This is done to get your child ready for painful medical procedures. When your child knows what to expect, then they can relax. The pain may seem easier to bear when your child is relaxed.

• Positive thinking. This helps your child put a positive spin on their 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 it helps your child feel in control.

• Acupressure. This stimulates certain areas of the body called acupoints. Massaging these points releases chemicals that may help reduce pain.

• Acupuncture. This stimulates certain areas of the body called acupoints by using small needles. But acupuncture may not be right for all kids.

• Biofeedback. This teaches 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 your child how to control these functions. Biofeedback can help reduce pain and give your child a sense of control over their pain.

• Hypnosis. This can help your child change how they think of pain. This is done with the help of a trained practitioner. Hypnosis can reduce pain and pain-linked 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 ease 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 they are in pain. Your child may also become irritable or moody. They may cry more often, lose their 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 some discomfort or pain. Ask your healthcare team to help you explain the procedure to your child and answer their questions. Reassure your child that you’ll be with them or nearby during the procedure.

• If your child is in pain, try touching and holding them. Stroke your child’s hair or head or hold their 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 can also help.

• Know that child life specialists, recreation therapists and counselors are resources many hospitals have to support children and help them manage pain.

• Ask your child’s provider for more information about managing pain in children.