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 1).
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 of ways.