Pain in pediatric oncology — children's and parents' perspectives

Abstract

There is a lack of valid epidemiological data on malignancy-associated pain in modern pediatric oncology. Pediatric oncology patients (self-assessment) and their parents from 28 hospitals were questioned using age-adapted, structured interviews and validated pain assessment tools. Pain intensity was measured by the NRS and Bieri faces scale. We conducted 363 interviews with patients and their parents, and 46 with the parents alone (if patients <2.5 years). Pain was reported at the time of the interview or within the last 24 h, 7 d, or 4 weeks in 15%, 28%, 50% and 58% of cases, respectively. The proportion of patients suffering severe to maximal pain (NRS>3; Bieri>2) increased significantly (p=0.001, chi2 test). The median pain intensity for the most severe pain episode within the last 4 weeks was 6.7 (NRS 0-10). Adverse effects of anti-tumor therapy were the most frequent cause of pain. Multivariate analyses depicted general physical condition either "severely reduced" (ASA status 3) (OR 4.0, 95% CI 1.1-14.7, p=0.037) or "moderately reduced" (ASA status 2) (OR 1.8, 95% CI 1.1-2.9, p=0.018), "in-patient status" (OR 1.8, 95% CI 1.2-2.9, p=0.010), and "co-morbidity present" (OR 3.5, 95% CI 1.1-10.7, p=0.030) as risk factors for severe to maximal pain. General anesthesia was the only factor significantly (OR 0.14, 95% CI 0.05-0.39, p<0.01) associated with a reduction in the proportion of patients suffering severe to maximal pain during bone marrow aspiration. Our data emphasize both the importance of in-house acute pain control and the need for general anesthesia during painful procedures in pediatric oncology.

Child's and Parents' Catastrophizing about Pain is Associated with Procedural Fear in Children: A Study in Children with Diabetes and Their Mothers

“…In addition, investigation of the impact of the child's and parents' catastrophizing for children undergoing more severe medical procedures (e.g., lumbar punctures; Zernikow et al, 2005) is needed to provide a stronger test of the hypotheses advanced within the present study and to further assess generalizability of the findings. However, the present findings are the first assessing child and parent catastrophizing thoughts about pain with regard to procedural pain and fear in the child.…”

Pain in Pediatric Oncology: Do the Experiences of Children and Parents Differ from Those of Nurses and Physicians?

“…Although there have been improvements in pain treatment in the last decades, pain and underestimation of pain are still common problems in pediatric oncology (1)(2)(3)(4)(5)(6). It has also been shown that fear of pain is a major concern of children with cancer (7,8).…”

Procedural pain in children: education and management. The approach of an Italian pediatric pain center

“…This service has many benefits: Sedation-analgesia is proposed for a large number of patients, including children with chronic conditions repeatedly needing painful procedures [38], procedures are performed outside the operating room [19], and therapy for procedural pain is tailored to each patient and includes a multimodal approach [2]. There is room for improvement relating to the need to record pain scores during and after a procedure; so far, pain has usually been scored, but the score has not been recorded on the Microsoft Access Support.…”

“…A sizable proportion of the procedures assisted by our Service was endoscopies. Children with cancer often report that repeated diagnostic-therapeutic procedures were the most painful experiences relating to their malignancy [38], while endoscopiesthough not particularly painful-are very distressing for children and often have to be repeated during a patient's follow-up. Being able to address and manage pain and distress during such procedures therefore has a great impact on the patient's and family's quality of life and can improve their treatment compliance.…”