Effective Management of Pain in Pediatric Hematology and Oncology

In the last several decades, there have been major advances in the treatment of pediatric cancers. 5 year survival 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 improving survival, the comprehensive care of children with cancer must offer total care including special emphasis on pain management and psychosocial support by a multidisciplinary team. Pain considerations in children are unique and differ from those in adults. For example, bone pain is often one of the presenting symptoms of leukemia in children, but can be mistaken for growing pain or labeled psychological. Bone pain is also a prominent symptom in late stage neuroblastoma, and of course in bone tumors. The American Medical Association and National Cancer Institute promote the absence of pain as a patient right and a marker of good clinical care and a quality of care issue. Pain due to disease burden responds dramatically to chemotherapy and the uninitiated are often surprised 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.