Childhood Cancer : Common Health Issues

by National Cancer Institute

(Page 9 of 14)

Pain relief, nutrition, treatment for infections, immunizations, bleeding, transfusions, and dental/mouth care are all part of supportive care. The goal of supportive care is to prevent or lessen the side effects of the treatment and the disease. With this care, your child can receive the needed therapy with greater safety and comfort. You may want to talk with your child's doctor or other members of the treatment team to see how the information provided below might help your child.

Pain

Your child may have pain for a variety of reasons. Pain may be caused by the cancer itself, or it could be from the treatment, such as surgery to remove a tumor or side effects of chemotherapy. Sometimes, cancer patients have pain that has nothing to do with the cancer, such as a toothache or a headache.

Not all children with cancer have pain. Those who do are not in pain all of the time.

Medicine and other treatments can almost always relieve cancer pain.

Relieving pain will not only make your child more comfortable, but also may help your child sleep and eat better.

Parents often feel helpless when their children are in pain. This reaction is natural. Knowing what to expect and what can be done to relieve pain can help. Talk with the doctor and treatment team about whether your child is likely to have pain, what pain treatment your child can receive, or what to do for your child if pain occurs.

How Is Pain Managed?

The best way to relieve pain is to treat its cause. If a tumor is causing pain, the doctor may try to remove the tumor or decrease its size using surgery, radiation therapy, and/or chemotherapy. Other ways to relieve or control pain include use of:

• direct pressure or cold or warm compresses
• pain medications
• physical therapy
• relaxation
• distraction
• imagery
• nerve blocks

Preventing pain from starting or getting worse is the best way to control it. Some people call this "staying on top of the pain." It may also mean that your child will need a lower dose of a pain reliever than if you wait until the pain gets bad. Different pain medicines take different lengths of time to work, from a few minutes to several hours. If your child waits too long to take pain medicine, the pain may get worse before the medicine helps.

To treat your child's pain, the doctor may start with medicines such as acetaminophen. If the pain increases, stronger drugs that require a prescription may be needed. Sometimes, opioids are prescribed. Narcotics are the strongest pain relievers available. Studies show that taking narcotics to relieve cancer pain will not make your child addicted to drugs. When your child is taking opioids, talk to the doctor, nurse, or pharmacist before giving him or her any other medications.

Work closely with the treatment team in sharing information about your child. For example, if you know that your child is afraid of needles, ask the doctor if your child can be given oral medicine. In older children and adolescents, the doctor may order a self-controlled drug "pump." This method uses a portable computerized pump containing pain medicine attached to a needle that is placed in a vein or attached to the central vein catheter. When pain relief is needed, the child presses a hand-held button, and the pump injects a preset dose of medicine into the vein. Pumps are programmed to give preset doses only at preset intervals, so even if the child presses button more than once during the preset interval, he or she will not get any more pain medication than is programmed.

How Will I Know How Bad My Child's Pain Is?

Treating pain in children requires a special understanding of the child and of the child's age. In some cases, you may need to speak for your child, especially if your child is younger than 4 years old. For infants and very young children, you can be of great help by closely watching the expressions on your child's face and carefully listening to the way your child cries. Take note of changes in behavior, such as sadness or isolation or decreased activity. The changes may mean that your child is in pain.

Sometimes, children have pain, but they may not be able to tell you about it. They may be afraid to. It is important to ask if your child has pain. Talk with your child about where and how much pain there is. Use words that your child knows, such as "boo-boo" or "ouch." A good way to determine the amount of pain your child has is to use a pain scale. A frequently used pain scale is the Wong- Baker FACES Pain Rating Scale, which can be used with children as young as 3 years old. On this scale, each face demonstrates a level of pain, from a person who feels happy because there is no pain (hurt) or sad because there is some or a lot of pain. Face 0 is very happy because there is no hurt. Face 1 hurts just a little bit. Face 2 hurts a little more. Face 3 hurts even more. Face 4 hurts a whole lot, but Face 5 hurts as much as you can imagine, although you do not have to be crying to feel this bad. Ask your child to choose the face that best describes the pain. Report the number under the chosen face to your child's nurse and doctor.

What If the Pain Is Not Being Controlled?

Cancer pain almost always can be greatly lessened or relieved, but no doctor can know everything about all medical problems. If your child's doctor is unable to control your child's pain, ask to see a pain specialist. Pain specialists may be oncologists, anesthesiologists, neurosurgeons, other doctors, nurses, or pharmacists. A pain control team may also include psychologists and social workers.

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