Managing Pain with Medicine

Doctors or nurse practitioners may prescribe medications for pain in a number of situations during pediatric cancer treatment. For example, patients may get medications during certain medical procedures or for pain that is a side effect of cancer treatment.

For long-lasting (chronic) pain, the medical team will most likely recommend it. The ultimate goals of any pain management plan are comfort, function, and overall quality of life.

Pediatric cancer procedure-related pain

Pediatric oncology clinics usually offer several pain management options for potentially painful procedures, such as a needle stick or more involved procedures such as a bone marrow aspiration or lumbar puncture. Patients receive pain medicines, or anesthesia, during surgical procedures.

Pain management medications may include

• Creams and patches put on the skin to numb the area.
• Mild sedation – medication for relaxation or brief sleep for a few minutes.
• Local anesthesia – numbing of a specific region of the body.
• Full general anesthesia – the patient sleeps and is not aware of the procedure.

Acute pain

Acute pain comes on quickly, caused by something specific such as a surgical procedure. When determining which medication to use, doctors consider a number of factors, including the cause of pain, the level of pain, and how much it affects the patient’s ability to function in everyday life.

In general, pain is classified as tissue-related or nerve-related.

• Tissue-related pain (also known as nociceptive or visceral pain) – Damage to tissues, organs, or bone causes this type of pain. The sensation usually feels like an ache, sharp stabbing, or throbbing. It may come and go or be constant.
• Nerve-related pain (neuropathic) – Nerve injury causes this type of pain. Some chemotherapy drugs, in particular vincristine, can cause nerve injury. The pain is often described as a shooting or burning pain or tingling. It can go away on its own but is often chronic.

Treatments for pain

Mild pain

For mild pain, doctors may give acetaminophen or non-steroid anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen.

Other NSAIDs that can be prescribed include celecoxib, choline magnesium trisalicylate and Ketorolac. However, NSAIDs are never given in conjunction with certain chemotherapy drugs such as high-dose methotrexate. Choline magnesium trisalicylate should not be used in cases of presumed or confirmed viral syndromes because of the association with Reye’s syndrome.

Moderate pain

For moderate pain, doctors may prescribe opioid medications such as codeine, oxycodone, and hydrocodone.

Severe pain

For more serious pain, doctors may prescribe the opioid drug morphine. When long-lasting pain is expected, patients may receive a patient-controlled analgesia (PCA). This method allows patients, or in some cases parents, to control the amount of pain medication.

For nerve-related pain, prescribed drugs may include gabapentin, an anti-seizure medication, and amitriptyline, an antidepressant drug. In some cases, doctors may prescribe steroid drugs.

Methods of delivery

Patients may receive pain medication:

• By swallowing
• Through a needle in a vein
• By a special catheter in the back
• Through a patch on the skin

Nerve block

A nerve block is another treatment option. It involves the injection of either a local anesthetic or a drug into or around a nerve to block pain. Nerve blocks help control pain that can't be controlled in other ways.

Medication safety

Patients may receive pain medication either at the hospital or at home.

• It is important that patients get the proper dosage at the proper time.
• Patients should only have medications approved by the doctor, including over-the-counter medicines. Certain medications can interfere with other treatments, cause side effects such as bleeding, or worsen existing side effects.
• Even if pain subsides, patients should not stop taking pain medications abruptly. Gradually stopping pain medicines helps avoid side effects. The slow decrease allows time for the body to adjust to not having the medicine. It does not means the patient is addicted.

Families often fear addiction to pain medications such as opioids, but there is no evidence of addiction in children receiving cancer treatment. Families should discuss any concerns with the medical team.