Pediatric Drugs

, Volume 18, Issue 3, pp 161–180 | Cite as

Pediatric Oncology: Managing Pain at the End of Life

  • Jennifer M. Snaman
  • Justin N. Baker
  • Jennifer H. Ehrentraut
  • Doralina L. Anghelescu
Review Article


Pain is a common and highly distressing symptom in pediatric patients with advanced malignancies. Prompt recognition, assessment, and treatment of pain are necessary, especially at the end of life. Opioid medications remain the mainstay of treatment of malignant pain in children at the end of life and the amount of opioids required for adequate pain control in patients is highly variable. Nonpharmacological approaches including behavioral and physical approaches in addition to non-opioid pain medications should be used when possible to augment pain control. Identification and treatment of any underlying pathology is important and use of adjuvant medications based on pathophysiology and source of pain should be considered. In cases where adequate pain control is not achieved through these multiple modalities, an interdisciplinary approach including potential interventional techniques and alternative treatments is required. This multimodal approach to pain management is best provided by interdisciplinary teams, as these teams can best address the complex causes of pain and associated distress that occurs in patients and within families.


Neuropathic Pain Gabapentin Zoledronic Acid Pregabalin Opioid Dose 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to thank Vani Shanker, PhD, ELS, for scientific editing of this manuscript, and members of the Child Life Program and biomedical communications groups at St. Jude Children’s Research Hospital for their support.

Compliance with Ethical Standards

Conflict of interest

The authors (Jennifer M. Snaman, Justin N. Baker, Jennifer H. Ehrentraut, and Doralina L. Anghelescu) do not have any conflicts of interest to report.


No funding was used in the preparation of this manuscript.

Supplementary material

40272_2016_168_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 26 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Jennifer M. Snaman
    • 1
  • Justin N. Baker
    • 1
  • Jennifer H. Ehrentraut
    • 2
  • Doralina L. Anghelescu
    • 3
  1. 1.Department of Oncology, Division of Quality of Life and Palliative CareSt. Jude Children’s Research HospitalMemphisUSA
  2. 2.Department of PsychologySt. Jude Children’s Research HospitalMemphisUSA
  3. 3.Department of Pediatric Medicine, Division of Anesthesiology, MS 130St. Jude Children’s Research HospitalMemphisUSA

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