Effective Management of Pain in Pediatric Hematology andOncology


In the last several decades, there have been major advances in the treatment of pediatric cancers. 5 yearsurvival of children with acute lymphoblastic leukemia has increased from 25% to 80%. Early stages of non-Hodgkin’s, Hodgkin’s and Wilms tumors all have more than 90% long term survival. In addition to improvingsurvival, the comprehensive care of children with cancer must offer total care including special emphasis on painmanagement and psychosocial support by a multidisciplinary team. Pain considerations in children are uniqueand differ from those in adults. For example, bone pain is often one of the presenting symptoms of leukemia inchildren, but can be mistaken for growing pain or labeled psychological. Bone pain is also a prominent symptomin late stage neuroblastoma, and of course in bone tumors. The American Medical Association and NationalCancer Institute promote the absence of pain as a patient right and a marker of good clinical care and a qualityof care issue. Pain due to disease burden responds dramatically to chemotherapy and the uninitiated are oftensurprised by the sudden increase in activity and playfulness of children undergoing induction chemotherapy.History and physical data, with special assessment of pain should be part of the medical record of all children.