Management of Cancer Pain in Children

Introduction

In general, the principles of pain management in children are similar to those in adults and readers are referred back to the main body of this guide for more detailed information. However, children are not small adults and the practitioner needs to modify his/her approach depending on the developmental level and maturity of the child’s physiological systems. Pain assessment tools and drug doses, which are based on body weight, need to be age-appropriate.

Many of the pain treatments that are used for adults have not been adequately studied in paediatric patients and there is insufficient evidence on which to base all treatment and dosing recommendations. However, the evidence base is growing and current guidelines (based mostly on expert opinion) are sufficient to manage most pain in children and, if followed correctly, are safe. In fact, especially with opioids, and if the drugs are used correctly, children experience fewer side effects than adults. Nevertheless, under-assessment and under-treatment of paediatric pain is common and fear of dosing in children often prohibits good pain control. Some medications are unsuitable and need to be avoided in children.

As for adults, involvement of a multidisciplinary team and effective communication is fundamental to providing adequate pain management in children. Furthermore, the role of parents and caregivers should not be forgotten. They should be involved from the outset, to facilitate communication between clinician and patient, to provide comfort and support to the child and to participate in treatment decisions.

The following is a guide to the management of cancer pain in children (see Assessment of Pain in Children and Analgesic Medication for Children with Cancer Pain). It is based on two paediatric guideline documents, namely those from the Hospice and Palliative Care Association of South Africa (http://www.hpca.co.za/resources) and from the World Health Organisation
(http://apps.who.int/medicinedocs/en/m/abstract/Js19116en/).^13,25 While the main aim is to guide the management of pain in neonates, infants and children aged 0-10 years, these recommendations may also be applied to adolescents as much of the information on which they were based refer to studies including patients aged from 0 to 18 years.¹³