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Managing pain

Seeing your child in pain is extremely difficult. This article can help you learn how to work with your child’s health care team to prevent or reduce pain that your child may have.

Controlling pain is an important part of treating children with cancer. Pain is not something that your child has to “put up with.” Your child will feel stronger and better during treatment if he doesn’t have pain. Pain can suppress the immune system, increase the time it takes the body to heal, interfere with sleep, and increase the chances of depression.

What causes pain?

These things may cause your child pain during treatment for cancer:

  • treatments, such as surgery
  • procedures, such as a bone marrow aspiration or a spinal tap
  • needle sticks for blood draws or injections
  • side effects, such as mouth sores, constipation, or diarrhea
  • cancer, such as when the tumor presses against nerves or other parts of the body

How can I tell if my child is in pain?

Trust your judgment and observations as a parent. If you think something isn’t right and your child may be in pain, talk with your child’s doctor. Signs of pain vary by age.

Very young children:

Babies and young children show discomfort by crying when touched. Or they may cry more often or have a different-sounding cry. Other signs of pain include not being able to be comforted or being withdrawn or tense. A change in sleeping or eating patterns, or tugging at a part of the body, may also be signs of pain in young children.

Older children:

Older children will usually tell you when something hurts. Still, some children do not want to let on that they are in pain because they do not want to upset you. Older children who have pain may wince, moan, or grimace. Their eyes may be red or puffy from crying. Encourage your child to tell you or the doctor about pain.

Who treats pain?

Pain experts may be oncologists, anesthesiologists, neurologists, surgeons, or other doctors, such as psychiatrists, psychologists, nurses, or pharmacists. Specialists in music or art therapy or those who practice acupuncture, biofeedback, massage therapy, or hypnosis may also help to reduce pain. These specialists often work together as part of a pain or palliative care team to assess your child’s pain and develop a pain control plan.

How is pain controlled?

Each child needs a personalized plan to control pain—based on their age, treatment, and side effects. You and your child’s health care team will work together to manage your child’s pain.

Over-the-counter pain medicines, such as ibuprofen or acetaminophen, may reduce pain and are a good first approach. Opioids may be prescribed if over-the-counter medicines do not work. Talk with your child’s doctor or nurse if you have concerns about the possibility of addiction to pain medicine. Not giving your child enough pain medicine can lead to pain that could have been prevented.

In addition to medicines, certain practices can be used to lower pain:

  • Distraction and relaxation. Playing games, listening to or reading books, or watching movies may distract or take your child’s focus away from the pain. Activities such as music, breathing exercises, or blowing bubbles may help to relax your child, which can lower pain, stress, and muscle tension.
  • Complementary practices such as massage or acupuncture. These practices may be effective in lowering pain.
  • Heat and cold therapy. A heating pad may relax muscles to help reduce pain. Cold packs may help reduce swelling and pain.
  • Exercise. Walking and other gentle exercises increase blood flow and raise endorphins (substances the body makes naturally to reduce pain and give a feeling of well-being).
  • Sleep. Being well rested may reduce children’s level of pain and improve their overall sense of well-being.

What steps can I take at home to help reduce pain?

Here are some ways you can help reduce pain levels when your child is at home:

  • Follow all instructions from your child’s doctor. You may be asked to take your child’s temperature and check with the doctor before giving some pain medicines. This is because some pain medicines can reduce fevers, which may mask, or hide, this sign of infection.
  • Give the pain medicine as prescribed. Make sure your child takes the correct amount of pain medicine at the right time. Don’t try to hold off, or wait until your child’s pain gets too bad, before giving pain medicine. Waiting  too long between doses could make the pain take longer to go away or increase the amount of pain medicine needed to lower pain.
  • Learn what side effects to expect from pain medicine. Pain medicine may cause sleepiness, stomach upset, constipation, or gas. These side effects may lessen over time, but your child’s health care team should always be told about them.
  • Use a pain scale. Ask for a pain scale from your child’s hospital that is age-appropriate. Ask your child questions such as: Where does it hurt? What does the pain feel like? How bad is the pain? When did the pain start?
  • Track your child’s level of pain. Keeping a written record of pain can help your child’s health care team to develop a pain control plan for your child. Take it with you to appointments. Keep a chart, or take notes, and write down information such as:

  1. the date and time your child had pain
  2. your child’s pain level when medicine was given
  3. the type and amount of pain medicine given
  4. what time it was when the pain went away or when the pain medicine was given again
  5. side effects or other problems from the pain medicine

“We use a chart at home to record Jessie’s pain level and then share it with his doctors. We found that the pain medicine worked well to keep his pain under control. Acupuncture also helped. Sometimes we watched movies, which helped to distract him from the discomfort.”

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