Cancer Pain
Description Referral ICD-10 code: G89.3 DESCRIPTION Pain in children with cancer is common and can be divided into four categories: Pain as a result of the disease. Pain secondary to treatment of the disease (chemo and radiotherapy). Procedural pain (especially from bone marrow aspirations and LPs). Pain from other causes as experienced by children in general. Pain caused by malignancy may
ICD-10 code: G89.3
DESCRIPTION
Pain in children with cancer is common and can be divided into four categories:
- Pain as a result of the disease.
- Pain secondary to treatment of the disease (chemo and radiotherapy).
- Procedural pain (especially from bone marrow aspirations and LPs).
- Pain from other causes as experienced by children in general.
- Pain caused by malignancy may be acute or chronic, acute-on-chronic or recurrent. It may be nociceptive or neuropathic or a combination of both. Sympathetic pain may occur with tumour infiltration of the sympathetic nervous system.
- Assessment of cancer pain follows the same general principles for pain assessment. The Eland Body Tool is particularly useful as a tool to identify multiple pain sites.
- General pain management also follows the basic principles of pain management with some extra considerations.
- Avoid NSAIDs in children with low platelets, renal dysfunction and dyspepsia.
- Procedural pain is common in children with cancer and may be more severe than pain related to the disease.
- Severe procedural pain is generally managed in oncology units with conscious sedation or general anaesthesia.
- Pain may have particular significance to the child and his/her parent or caregiver especially when it is the presenting feature of relapse.
- Children with cancer may under-report their pain for fear of further treatments.
- Pain is a common end-of-life symptom in terminally ill children that often requires escalating doses of opiates or opiate rotation to control it
| Pain type | Clinical presentation | Causes/mechanism | Treatment |
| Bone pain. | Aching to sharp, severe pain, more pronounced with movement. Point tenderness common. | Primary and secondary (metatases). Strong neuropathic component (periosteum, Haversian canals). |
- NSAIDs - Corticosteroids - Opioids - Adjuvants: Amitriptyline |
| Neuropathic pain. | Pain described as tingling, burning or stabbing. Dysethesia: Allodynia and hyperalgaesia, Sometimes numbness, formication. | Nerve invasion by tumour. Chemotherapy side effects (vincristine, cisplatin, paclitaxel). Nerve entrapment. Phantom pain post amputation. |
- Seek specialist advice. - Treatment underlying cause consider radiation. - Start NSAID if no contra-indications - Opioids (morphine). - Add: Amitriptyline |
| Visceral pain. Pain arising from organs. Tumours of bowel ± obstruction. Retroperitoneal tumors. | Poorly localised pain. Varies in intensity. Deep aching pain. |
Tumour infiltration. Serosal stretch. Obstruction |
- Consider hyoscine butylbromide for cramps. - Low dose morphine. |
| Mucositis | Oral pain. Odynophagia Mucosal ulceration. Drooling |
Post chemotherapy. Radiotherapy |
See: Palliative care, Odynophagia |
| Post-surgical | Pain related to tissue trauma post-surgery. | See: Post-op pain management. |
REFERRAL
- All patients.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 20: Pain Control, 20.1.1 Management of Pain, 20.1.1.3 Cancer Pain