LONDON, Ontario-For a child with cancer, the pain related to the
disease, its therapy, and required procedures is quite often the
worst pain that the child has ever encountered, said Patricia
A. McGrath, PhD, in her presentation at the World Health Organization
workshop session on cancer pain.
Children may be terrified of cancer-related procedures and even
struggle to get away, she said, but clinicians can take advantage
of a fact that underlies the WHO's new guidelines for the management
of pediatric cancer pain: The child's pain system is plastic,
and may be intensified by situation-specific factors that often
can be modified.
"A finger prick, for example, creates a sequence of activity
in nerves that respond to tissue damage, but
the final pain that the child experiences is related to the situation
and context in which that finger prick is delivered," said
Dr. McGrath, director, Child Health Research Institute, University
of Western Ontario, London.
She contrasted a distressed 7-year-old cancer patient, whose pain
rating of this procedure was high, with a calm child with the
same kind of cancer who performed the procedure herself (see Figure
The child had learned that if she vigorously rubbed her finger
just before pricking it, the pain intensity would not be as strong
or last as long. "She was intently absorbed in doing the
procedure and reported almost no pain from the exact same kind
of tissue damage that produced a great deal of pain in the distressed
child," Dr. McGrath said.
Health care professionals can help children decrease their anxiety
or fear of procedures, and thus decrease their pain, in a number