Pain in Childhood Cancer

Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Pain is a common symptom in people with cancer. However, up to 95% of cancer pain can be treated successfully. Untreated pain can make other aspects of cancer, such as constipation, anxiety,  fatigue, shortness of breath, depression, nausea, weakness, sleep disturbances, and mental confusion, seem worse.

Some individuals are concerned that pain medication is addictive or will make them sleepy or groggy so do not report the pain to their healthcare team. This is not a good idea as pain can result in your child’s overall wellness and their healing suffering. Your child’s doctor or a pain specialist can help you find a medication that works for them and suggest other methods of pain relief in addition to medication.

Cancer-related pain that is not addressed can make other symptoms or side effects of cancer seem worse. A person may also experience unnecessary fatigue, depression, anger, worry, or stress. Finding a solution for the pain will help your child remain active, sleep better, improve their appetite, and enjoy activities and time spent with their family and friends.

Causes

There are many reasons why your child may have pain; it can be because of the cancer itself, from the cancer treatment, or can be as a result of causes unrelated to cancer:

• Tumour: A tumour growing in an organ may stretch part of the organ, which can cause pain. If a tumour grows and spreads to the bones or other organs, it may put pressure on nerves and damage them, causing pain. If a tumour spreads or grows around the spinal cord, it can cause a compression of the spinal cord, which eventually leads to severe pain or paralysis if not treated.
• Surgery: It is normal to experience pain from cancer surgery. Most of the pain will go away after a while, but some individuals may have persistent pain for months or years from permanent damage to the nerves and the development of scar tissue.
• Radiation Therapy: Pain may develop after radiation therapy and go away on its own. It can also develop months or years after treatment, especially after radiation therapy to the breast, chest, or spinal cord.
• Chemotherapy: Some chemotherapy treatments can cause pain along with numbness in the fingers and toes. This pain generally goes away once the treatment is finished, but the damage is sometimes permanent.
• Other Causes: Individuals with cancer can still have pain from other causes such as migraines, arthritis, or chronic low back pain. The treatment plan your child’s doctors develop with you should also include these kinds of pain, because any pain decreases your child’s quality of life.

A good pain treatment plan will normally take care of any type of pain, no matter the cause, so there is certainly no need for your child to suffer any form of pain.

Diagnosis

The type, intensity, and location of pain is different for everyone. Identifying the cause and finding an effective solution for your child’s pain requires teamwork between you and your child’s doctor. In order to diagnose and understand the type of pain that your child is experiencing and work out a plan to mediate the pain, the doctor may ask the following questions:

• Where does it hurt?
• When does the pain stop and start?
• How long has it been there?
• How intense is the pain?
• What does the pain feel like, in your own words?

Your child’s doctor may also ask you or them to describe how much pain they are having by using a scale from 0 -10, or offer words that help describe the pain, such as burning, stabbing, or throbbing.

In order to make it easier to give your child’s doctor all the relevant information as to the type, location and level of the pain, it is recommended that you keep a pain journal of your child’s pain, noting down as much as you can as well as to including information about pain caused by other health conditions they may have.

Facts to include in the Pain Journal:

• The date and time your child experienced the pain and how long it lasted.
• What activities your child was doing when the pain started.
• Where in your child’s body the pain started and whether it was specific to one area or spread to other parts of the body.
• Rate your child’s pain on a scale of 0- 10, with 10 being the highest level of pain.
• Use Descriptive Words for the type of pain, such as “burning,” “stabbing,” or “throbbing.”
• Track the pain control methods you tried for your child and how effectively they worked.

Management/Treatment

Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.

There are different types of cancer pain; pain may last just a short time after a particular treatment or other event; pain that only occurs from time to time; and pain that is long-lasting and constant. Pain may also increase suddenly even though it is being treated; this is called breakthrough pain and generally happens during or after some type of activity.

Cancer pain can be treated and/or managed in a variety of ways, including the use of pain medication and methods that do not use medication.

Pain-Relief Strategies

Once your child’s pain has been assessed, their doctor will develop a pain-relief plan. Some hospitals have pain specialists and palliative care specialists who focus on the physical and emotional side effects of cancer and help patients who have pain that is hard to control.

Doctors can treat or manage cancer-related pain in different ways:

• Treating the Source of the Pain: Pain is often caused by a tumour putting pressure on nerves; surgical removal of or shrinking the tumour with radiation therapy or chemotherapy could reduce or eliminate the pain.
• Changing the Perception of Pain: Some medications can change how one’s body feels pain, making it more tolerable.
• Interfering with Pain Signals to the Brain: If medication does not work, your child’s doctor may consider using specialised medical procedures including spinal treatments or pain medication injected into a nerve or tissue surrounding a nerve to interfere with a pain signal.

Pain Medications

One of the most effective methods of treating cancer-related pain is to either prevent it from developing or from getting worse. Pain medication is generally administered at regular, scheduled times but doctors also use “rescue” or extra doses to help control breakthrough pain if it occurs.

There are various pain-relief medications (analgesics) available, which can administered in different ways, depending on the drug and your child’s condition; some are taken orally (by mouth), while others are injected into a vein or worn as a skin patch.

• Non-Opioid Medications, such as Tylenol or Ibuprofen are used to treat mild or moderate pain. Doctors also sometimes prescribe them along with other pain medicines for severe pain. These types of pain medication can be bought over-the-counter (without prescription), but you should talk with your doctor about how often and how long to use them and the appropriate dose for your child. It is very important to tell your doctor if your child is using any of these medications regularly without a recommendation from a doctor.
• Opioids, which are also called narcotics, are used for moderate to severe pain. They are often taken along with non-opioid medications. Opioids require a prescription and these extra strong pain relievers should be securely stored that nobody, including your child, can get to them. Use of these drugs without a medical reason or in too large doses could lead to serious side effects or an overdose.
• Other Medications, such as antidepressants and anti-seizure medicines, may also be recommended to help relieve some types of pain, especially nerve-related pain.

Medication is not the only option for controlling pain; many other methods are available, including complementary therapy (treatments used in addition to and alongside conventional medicine), such as physical therapy, distraction techniques, acupuncture, and massage.

The most complete and potentially successful approach to pain control is often a combination of several methods.

Common Pain Management Concerns

Some individuals do not want to tell their doctor they are experiencing pain because they are scared it means the cancer has worsened or spread (your child might feel the same, so make sure that you monitor them to see if they have pain that they are not telling you about.)

Some people feel that pain is simply part of living with cancer and that they should not complain. Children also sometimes feel that they are being a bother if they constantly complain about pain, or wish to protect their parents so say nothing.

Although these thoughts are understandable, there are many reasons pain occurs, and every patient has the right to live without pain.

Some patients worry about becoming addicted to pain medication, and while this is certainly a valid concern, it is uncommon if medication is used appropriately. Your child’s healthcare team is trained to carefully monitor people on pain medication and can help safely decrease your child’s dose when they no longer need treatment.

It is also normal for people with cancer to worry about the side-effects of medications, and this is especially true of parents who have a child with cancer. Although some medications, particularly those for moderate or severe pain, cause side effects such as constipation, nausea, sleepiness, or confusion, not everyone experiences them and they often go away over time or are treatable.

If a side effect does not go away, or if a medication your child is taking is not effective, tell their doctor. Changing the timing, dose, or type of the medication may help.

Additional Methods of Managing Pain

While traditional medication often plays an important role in relieving pain related to cancer and its treatment, there are also many medication-free, self-care and support options available. Some of these methods have been very successful in helping people with cancer better manage their pain and may also help reduce stress, depression, and anxiety.

• Acupuncture is an ancient form of Chinese medicine that involves inserting special needles into specific areas of the body. Read more about Acupuncture
• Biofeedback is a technique that helps one control your body’s functions, such as your heart rate. Read more about Biofeedback
• Breathing Exercises/Meditation – Gentle breathing exercises can enhance relaxation, reduce tension, and decrease pain. You can also try meditation exercises. These include softly repeating a calming word or imagining breathing heat, coolness, or a feeling of relaxation in and out of areas of pain in your body. Read more about Meditation
• Counselling and Support Groups – Speaking to a trained counsellor or attending a cancer support group can help both your child and you to deal with the cancer, to learn about pain management techniques that have worked for others and that may work for your child. Discussing concerns and getting support may either from a professional or from people who are going through the same ordeal can also relieve some of the physical and emotional tension that often makes pain worse.
• Distraction means doing certain activities that can distract your mind from pain such as taking a warm bath; reading a book; watching television or a movie; drawing; doing needlework; listening to music; playing computer games, or taking a short walk outdoors
• Heat and Cold – Some individuals find that applying hot or cold compresses, heating pads, or ice packs to aching, sore, or painful areas of the body helps for the pain. Discuss this approach with your child’s doctor and follow any special instructions, particularly during or after radiation therapy or chemotherapy. Start with short applications of five to 10 minutes at moderate temperatures. Do not apply heat or cold directly to bare or injured skin; areas that are numb; or areas that have received recent radiation therapy.  Wrap ice packs and compresses in a towel and use heating pads over clothing, a sheet, or a towel to protect the skin. Experiment with temperatures to find a method that provides relief comfortably.
• Imagery and Visualisation – Many imagery techniques are useful for pain and discomfort associated with treatment. For example, your child may benefit from simple visualisation exercises in which they imagine a peaceful scene, replay a favourite memory, or create a mental picture of a healing light that takes pain away. A trained therapist can teach you different exercises to do at home. Read more about Imagery and Visualisation
• Massage – A qualified massage therapist who has experience working with people with cancer can provide gentle therapeutic massage. This may help alleviate tension, discomfort, and pain. A caregiver can do simple massage techniques at home, including gentle, smooth, circular rubbing of the feet, hands, or back. You can also massage yourself by applying light, even pressure to your hands, arms, neck, and forehead. Read more about Massage
• Nutritional Support – Cancer and cancer treatments sometimes cause side effects, such as mouth sores or nausea, that make it difficult to maintain proper nutrition. Not getting enough vitamins, minerals, and other important nutrients from food can cause pain or discomfort or worsen these sensations. Read more about Nutrition
• Physical Therapy or Occupational Therapy – A physical therapist evaluates nerve, muscle, and fitness problems that make it difficult for a person to function well on a daily basis. He or she can teach you how to relieve pain using simple exercises, or sometimes with devices, such as artificial body parts, splints, or braces. An occupational therapist helps people prevent and live with illness, injury, and disability. For example, an occupational therapist may help someone avoid lymphedema, which is a painful build-up of fluid, after cancer surgery.