Pain and Pain-Related Distress in Children With Cancer

  • Sharon L. Manne
  • Barbara L. Andersen


Cancer in children is relatively rare, accounting for slightly less than 1 % of the 1 million cases of cancer diagnosed annually in the United States (Silver-berg, Boring, & Squires, 1990). When it occurs, however, it can be fatal. Cancer is the second leading cause of death among individuals 14 years of age or less, and accounts for 10 to 12% of the annual childhood deaths (Silverberg et al., 1990). Although there are cardinal signs and symptoms of cancer in children (Fernbach, 1984), including fever, a tumor mass, pallor, changes in balance, gait, or personality, or changes in the eye, pain is perhaps the most classic sign or symptom. For example, bone pain has been found in 15 to 52% of children presenting with leukemia (Fernbach, 1984; Miser, McCalla, Dothage, Wesley, & Miser, 1987), the most common form of childhood cancer. Pain often accompanies the remaining prevalent sites of disease, including brain tumors (headache), kidney tumors (abdominal pain), and soft tissue disease (a painful mass with rhabdomyosarcoma) (Miser et al., 1987). Thus, it is often the child’s complaint of pain or their parents’ suspicion that the child is in pain, from seeing changes in his/her behavior or affect, that prompts a visit to a physician.


Acute Lymphocytic Leukemia Bone Marrow Aspiration Pediatric Cancer Painful Procedure Child Distress 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abu-Saad, H. (1984). Assessing children’s responses to pain. Pain, 19, 163–171.PubMedCrossRefGoogle Scholar
  2. Baum, E., Suther, H., & Nachman, J. (1979). Relapse rates following cessation of chemotherapy during complete remission of ALL. Medical Pediatric Oncology, 1, 25–34.CrossRefGoogle Scholar
  3. Berde, C., Albin, A., Glazer, J., Miser, A., Shapiro, B., Weisman, S., & Zeltzer, P. (1990). Report of the Subcommittee on Disease-Related Pain in Childhood Cancer. In N. Schechter, A. Altman, & S. Weisman (Eds.), Report of the Consensus Conference on the Management of Pain in Childhood Cancer. Pediatrics, 86(5), supplement.Google Scholar
  4. Bibace, R., & Walsh, M. (1979). Developmental stages in children’s conceptions of illness. In G. Stone, F. Cohen, & N. Adler (Eds.), Health psychology. Washington: Jossey-Bass.Google Scholar
  5. Bibace, R., & Walsh, M. (1980). Development of children’s concepts of illness. Pediatrics, 66, 912–917.PubMedGoogle Scholar
  6. Blount, R., Corbin, S., Sturges, J., Wolfe, V., Prater, J., & James, L. (1989). The relationship between adults’ behavior and child coping and distress during BMA/ LP procedures: A sequential analysis. Behavior Therapy, 20, 585–601.CrossRefGoogle Scholar
  7. Bush, J., & Holmbeck, G. (1987). Children’s attitudes about health care: Initial development of a questionnaire. Journal of Pediatric Psychology, 12, 429–443.PubMedCrossRefGoogle Scholar
  8. Carabell, S. C., Cassady, J. R., Weinstein, H. J., & Jaffe, N. (1978). The role of radiation therapy in the treatment of pediatric non-Hodgkin’s lymphomas. Cancer, 42, 2193–2205.PubMedCrossRefGoogle Scholar
  9. Clarke, S., & Radford, M. (1986). Topical anesthesia for venipuncture. Archives of Disease in Childhood, 61, 1132–1134.PubMedCrossRefGoogle Scholar
  10. Craig, K., McMahon, R., Morison, J., & Zaskow, C. (1984). Developmental changes in infant pain expression during immunization injections. Social Science and Medicine, 19, 1331–1337.PubMedCrossRefGoogle Scholar
  11. Dahlquist, L., Gil, K., Armstrong, F., Ginsberg, A., & Jones, B. (1985). Behavioral management of children’s distress during chemotherapy. Journal of Behavior Therapy and Experimental Psychiatry, 16, 325–329.PubMedCrossRefGoogle Scholar
  12. D’Angio, G. J., Evans, A. E., Breslow, N., Beckwith, B., Baum, E., DeLorimier, A., Farewell, V., Fernbach, D., Hrabovsky, E., & Jones, B. (1984). Results of the Third National Wilms’ Tumor Study: A preliminary report. Proceedings of the Annual Meeting of the American Association of Cancer Research, 25, 183–185.Google Scholar
  13. Duffner, P., Cohen, M., & Freeman, A. (1985). Pediatric brain tumors: An overview. Ca-A Cancer Journal for Clinicians, 35, 287–301.PubMedCrossRefGoogle Scholar
  14. Eckman, P. (1984). Expression and the nature of emotion. In K. Scherer & P. Eckman (Eds.), Approaches to emotion (pp. 319–343). Hillsdale, NJ: Erlbaum.Google Scholar
  15. Eckman, P., & Oster, H. (1979). Facial expression of emotion. Annual Review of Psychology, 30, 527–554.CrossRefGoogle Scholar
  16. Elliott, C., Jay, S., & Woody, P. (1987). An observational scale for measuring children’s distress during medical procedures. Journal of Pediatric Psychology, 12, 543–551.PubMedCrossRefGoogle Scholar
  17. Everson, T. C., & Cole, W. H. (1966). Spontaneous regression of cancer. Philadelphia: W. B. Saunders.Google Scholar
  18. Fernbach, D. J. (1984). Natural history of acute leukemia. In W. W. Sutrow, D. J. Fernbach, & T. J. Vietti (Eds.), Clinical pediatric oncology (pp. 332–377). St. Louis: C. V. Mosby.Google Scholar
  19. Gauvain-Piquard, A., Rodary, C., Rezvani, A., & Lemerle, J. (1987). Pain in children aged 2–6 years: A new observational rating scale elaborated in a pediatric oncology unit-preliminary report. Pain, 31, 177–188.PubMedCrossRefGoogle Scholar
  20. Glatstein, E., Kim, H., Donaldson, S. S., Dorfman, R. F., Gribble, T. J., Wilbur, J. R., Rosenberg, S., & Kaplan, H. S. (1974). Non-Hodgkin’s lymphomas. VI. Results of treatment in childhood. Cancer, 34, 204–211.PubMedCrossRefGoogle Scholar
  21. Henderson, E. D., & Dahlin, D. C. (1963). Chondrosarcoma of bone —A study of 288 cases. Journal of Bone and Joint Surgery, 45A, 1450–1458.Google Scholar
  22. Hilgard, J., & LeBaron, S. (1982). Relief of anxiety and pain in children and adolescents with cancer: Quantitative measures and clinical observations. International Journal of Clinical and Experimental Hypnosis, 30, 417–442.PubMedCrossRefGoogle Scholar
  23. Hops, H., Wills, T., Patterson, G., & Weiss, R. (1972). Marital interaction coding system. Unpublished manuscript, University of Oregon and Oregon Research Institute, Eugene, Oregon.Google Scholar
  24. Izard, C. E., & Buechler, S. (1979). Emotion expressions and personality integration in infancy. In C. E. Izard (Ed.), Emotions in personality and psychopathology (pp. 445–472). New York: Plenum.Google Scholar
  25. Jay, S., & Elliott, C. (1984). Behavioral observation scales for measuring children’s distress: The effects of increased methodological rigor. Journal of Consulting and Clinical Psychology, 52, 1106–1107.PubMedCrossRefGoogle Scholar
  26. Jay, S., Elliott, C., Katz, E., & Siegel, S. (1987). Cognitive-behavioral and pharmacologic interventions for childrens’ distress during painful medical procedures. Journal of Consulting and Clinical Psychology, 55, 860–865.PubMedCrossRefGoogle Scholar
  27. Jay, S., Elliott, C., Ozolins, M., Olson, R., & Pruitt, S. (1985). Behavioral management of children’s distress during painful medical procedures. Behaviour Research and Therapy, 5, 513–520.CrossRefGoogle Scholar
  28. Jay, S., Ozolins, M., Elliott, C., & Caldwell, S. (1983). Assessment of children’s distress during painful medical procedures. Health Psychology, 2, 133–147.CrossRefGoogle Scholar
  29. Johnston, C., & Strada, M. (1986). Acute pain response in infants: A multidimensional description. Pain, 24, 373–382.PubMedCrossRefGoogle Scholar
  30. Katz, E., Kellerman, J., & Ellenberg, L. (1987). Hypnosis in the reduction of acute pain and distress in children with cancer. Journal of Pediatric Psychology, 12, 379–394.PubMedCrossRefGoogle Scholar
  31. Katz, E., Kellerman, J., & Siegel, S. (1980). Behavioral distress in children with cancer undergoing medical procedures: Developmental considerations. Journal of Consulting and Clinical Psychology, 48, 356–365.PubMedCrossRefGoogle Scholar
  32. Kellerman, J., Zeltzer, L., Ellenberg, L., & Dash, J. (1983). Adolescents with cancer: Hypnosis for the reduction of the acute pain and anxiety associated with medical procedures. Journal of Adolescent Health Care, 4, 85–90.PubMedCrossRefGoogle Scholar
  33. Knudson, A. G., & Strong, L. C. (1973). Mutation and cancer: A model for Wilms’ tumor of the kidney. Journal of the National Cancer Institute, 48, 313–324.Google Scholar
  34. Kuttner, L., Bowman, M., & Teasdale, M. (1988). Psychological treatment of distress, pain and anxiety for young children with cancer. Developmental and Behavioral Pediatrics, 9, 374–381.CrossRefGoogle Scholar
  35. LaBaw, W., Holton, C., Tewell, K., & Eccles, D. (1975). The use of self-hypnosis by children with cancer. American Journal of Clinical Hypnosis, 17, 233–238.PubMedCrossRefGoogle Scholar
  36. LeBaron, S., & Zeltzer, L. (1984). Assessment of acute pain and anxiety in children and adolescents by self-reports, observer reports, and a behavior checklist. Journal of Consulting and Clinical Psychology, 52, 729–738.PubMedCrossRefGoogle Scholar
  37. Lollar, D., Smits, S., & Patterson, D. (1982). Assessment of pediatric pain: An empirical perspective. Journal of Pediatric Psychology, 7, 267–277.PubMedCrossRefGoogle Scholar
  38. Manne, S., Bakeman, R., Jacobsen, P., Gorfinkle, K., Bernstein, D., & Redd, W. H. (in press). Adult and child interaction during invasive medical procedures: A sequential analysis.Google Scholar
  39. Manne, S., Jacobsen, P., & Redd, W. H. (in press). Assessment of acute pediatric pain: Do child self-report, parent ratings, and nurse ratings measure the same phenomenon? Pain.Google Scholar
  40. Manne, S., Redd, W. H., Jacobsen, P., Gorfinkle, K., Schorr, O., & Rapkin, B. (1990). Behavioral intervention to reduce child and parent distress during venipuncture. Journal of Consulting and Clinical Psychology, 58, 565–572.PubMedCrossRefGoogle Scholar
  41. Marcove, R. C., & Rosen, G. (1980). En bloc resections for osteogenic sarcoma. Cancer, 45, 3040–3044.PubMedCrossRefGoogle Scholar
  42. Maurer, H. M., Donaldson, M., Gehan, E. A., Hammond, D., Hays, D. M., Lawrence, W., Lindberg, R., Newton, W., Ragab, A., Raney, B., Ruymann, F., Soule, E., Sutow, W., & Tefft, M. (1981). The intergroup rhabdomyosarcoma study. Update, November, 1978. Journal of the National Cancer Institute Monograph, 56, 61–68.Google Scholar
  43. McGrath, P. J., Beyer, J., Cleeland, C., Eland, J., McGrath, P. A., & Portenoy, R. (1990). Report of the Subcommittee on Assessment and Methodologic Issues in the Management of Pain in Childhood Cancer. In N. Schechter, A. Altman, & S. Weisman (Eds.), Report of the Consensus Conference on the Management of Pain in Childhood Cancer. Pediatrics, 86(5) suppl.Google Scholar
  44. McGrath, P. A., & deVeber, L. (1986). The management of acute pain evoked by medical procedures in children with cancer. Journal of Pain and Symptom Management, 1, 145–150.PubMedCrossRefGoogle Scholar
  45. Melamed, B., & Siegel, L. (1975). Reduction in anxiety in children facing hospitalization and surgery by use of filmed modeling. Journal of Consulting and Clinical Psychology, 43, 511–521.PubMedCrossRefGoogle Scholar
  46. Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1, 277–299.PubMedCrossRefGoogle Scholar
  47. Merskey, H. (1970). On the development of pain. Headache, 10, 116–123.PubMedCrossRefGoogle Scholar
  48. Michielutte, R., & Diseker, R. A. (1982). Children’s perceptions of cancer in comparison to other chronic illnesses. Journal of Chronic Diseases, 35, 843–852.PubMedCrossRefGoogle Scholar
  49. Miller, R. W., & Dalager, N. A. (1974). Fatal rhabdomyosarcoma among children in the United States 1960–69. Cancer, 34, 1897–1900.PubMedCrossRefGoogle Scholar
  50. Mills, N. (1989). Pain behaviors in infants and toddlers. Journal of Pain and Symptom Management, 4, 184–190.PubMedCrossRefGoogle Scholar
  51. Miser, A., Davis, D., Hughes, C., Mulne, A., & Miser, J. (1983). Continuous infusion of morphine in children with cancer. American Journal of Diseases in Children, 137, 383–385.Google Scholar
  52. Miser, A., McCalla, J., Dothage, J., Wesley, M., & Miser, J. (1987). Pain as a presenting symptom in children and young adults with newly diagnosed malignancy. Pain, 29, 85–90.PubMedCrossRefGoogle Scholar
  53. Miser, A., & Miser, J. (1986). The use of oral methadone to control moderate and severe pain in children and young adults with malignancy. Clinical Journal of Pain, 1, 243–248.CrossRefGoogle Scholar
  54. Miser, A., Miser, J., & Clark, B. (1980). Continuous intravenous infusion of morphine sulphate for control of severe pain in children with terminal malignancy. Journal of Pediatrics, 96, 930–932.PubMedCrossRefGoogle Scholar
  55. Okamura, J., Sutow, W. W., & Moon, T. E. (1977). Prognosis in children with metastatic rhabdomyosarcoma. Medical Pediatric Oncology, 3, 243–251.CrossRefGoogle Scholar
  56. Olness, K. (1981). Imagery (self-hypnosis) as adjunct therapy in childhood cancer. American Journal of Pediatric Hematology/Oncology, 1, 313–321.Google Scholar
  57. Owens, M. E. (1984). Pain in infancy: Conceptual and methodological issues. Pain, 20, 213–230.PubMedCrossRefGoogle Scholar
  58. Perrin, E., & Gerrity, P. (1981). There’s a demon in your belly: Children’s understanding of illness. Pediatrics, 67, 841–849.PubMedGoogle Scholar
  59. Poznanski, F. O. (1976). Children’s reactions to pain: A psychiatrist’s perspective. Clinical Pediatrics, 15, 1114–1119.PubMedCrossRefGoogle Scholar
  60. Pui, C., & Crist, W. M. (1990). Pediatric solid tumors. In A. Holleb & D. Fink (Eds.), Clinical oncology. Atlanta, GA: American Cancer Society.Google Scholar
  61. Pui, C., & Rivera, G. K. (1990). Childhood leukemia. In A. Holleb & D. Fink (Eds.), Clinical oncology. Atlanta, GA: American Cancer Society.Google Scholar
  62. Ross, D. M., & Ross, S. A. (1984). Childhood pain: The school-aged child’s viewpoint. Pain, 20, 179–191.PubMedCrossRefGoogle Scholar
  63. Sanders, M., Rebgetz, M., Morrison, M., Bor, W., Gordon, A., Dadds, M., & Shepherd, R. (1989). Cognitive-behavioral treatment of recurrent nonspecific abdominal pain in children: An analysis of generalization, maintenance, and side effects. Journal of Consulting and Clinical Psychology, 57, 294–300.PubMedCrossRefGoogle Scholar
  64. Schechter, N. L. (1985). Pain and pain control in children. Current Problems in Pediatrics, 15, 1–67.PubMedCrossRefGoogle Scholar
  65. Schechter, N., Allen, D. A., & Hanson, K. (1986). Status of pediatric pain control: A comparison of analgesic usage in children and adults. Pediatrics, 77, 11–15.PubMedGoogle Scholar
  66. Scott, P., Ansell, B., & Huskisson, E. (1977). Measurement of pain in juvenile chronic polyarthritis. Annals of Rheumatic Diseases, 36, 186–187.CrossRefGoogle Scholar
  67. Scott, P., & Huskisson, E. (1976). Graphic representation of pain. Pain, 2, 175–184.PubMedCrossRefGoogle Scholar
  68. Siegel, L., & Peterson, L. (1981). Maintenance effects of coping skills and sensory information on young children’s response to repeated dental procedures. Behavior Therapy, 12, 530–535.CrossRefGoogle Scholar
  69. Silverberg, B. S., Boring, C. C., & Squires, B. A. (1990). Cancer statistics, 1990. Ca—A Cancer Journal for Clinicians, 40, 9–26.PubMedCrossRefGoogle Scholar
  70. Silverstein, M. N., & Kelly, P. J. (1963). Leukemia with osteoarticular symptoms and signs. Annals of Internal Medicine, 59, 637–645.PubMedGoogle Scholar
  71. Simmons, C. R., Harle, T. S., & Singleton, E. B. (1968). The osseous manifestations of leukemia in children. Radiologic Clinics of North America, 6, 115–130.PubMedGoogle Scholar
  72. Smith, K., Ackerman, J., & Blotcky, A. (1989). Reducing distress during invasive medical procedures: Relating behavioral interventions to preferred coping style in pediatric cancer patients. Journal of Pediatric Psychology, 14, 405–419.PubMedCrossRefGoogle Scholar
  73. Steif, B., & Heiligenstein, E. (1989). Psychiatric symptoms of pediatric cancer pain. Journal of Pain and Symptom Management, 4, 191–196.PubMedCrossRefGoogle Scholar
  74. Swank, R. L., Fetterman, G. H., Sieber, W. K., & Kiesewetter, W. B. (1971). Prognostic factors in neuroblastoma. Annals of Surgery, 174, 428–435.PubMedCrossRefGoogle Scholar
  75. Talbert, L. M., Kraybill, E. N., & Potter, H. D. (1975). Adrenal cortical response to circumcision in the neonate. Obstetrics and Gynecology, 48, 208–210.Google Scholar
  76. Turk, D. (1978). Cognitive behavioral techniques in the management of pain. In J. P. Foreyt & D. P. Rathjen (Eds.), Cognitive behavior therapy (pp. 199–227). New York: Plenum.CrossRefGoogle Scholar
  77. Varni, J., Thompson, K., & Hanson, V. (1987). The Varni/Thompson Pediatric Pain Questionnaire. I. Chronic musculoskeletal pain in juvenile rheumatoid arthritis. Pain, 28, 27–38.PubMedCrossRefGoogle Scholar
  78. Wahlstedt, C., Kollberg, H., Moller, C., & Uppfeldt, A. (1984). Lignocaine-Prilocaine cream reduces venipuncture pain. Lancet,Google Scholar
  79. Wolff, P. H. (1969). The natural history of crying and other vocalizations in early infancy. In B. Foss (Ed.), Determinants of infant behavior (Vol. 4, pp. 81–115). London: Methuen.Google Scholar
  80. Wollner, N., Burchenal, J. H., Lieberman, P. H., Exelby, P., D’Angio, G., & Murphy, M. L. (1976). A comparative study of 2 modalities of therapy. Cancer, 37, 123–134.PubMedCrossRefGoogle Scholar
  81. Yaster, M., & Deshpande, J. (1988). Management of pediatric pain with opioid analgesics. Journal of Pediatrics, 113, 421–429.PubMedCrossRefGoogle Scholar
  82. Young, J. L., & Miller, R. W. (1975). Incidence of malignant tumors in U.S. children. Journal of Pediatrics, 86, 254–258.PubMedCrossRefGoogle Scholar
  83. Zeltzer, L., & LeBaron, S. (1982). Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. Journal of Pediatrics, 101, 1032–1035.PubMedCrossRefGoogle Scholar
  84. Ziegler, J. L., Bluming, A. Z., Morrow, R. H., Fass, L., & Carbone, P. (1970). Central nervous system involvement in Burkitt’s lymphoma. Blood, 36, 718–728.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1991

Authors and Affiliations

  • Sharon L. Manne
  • Barbara L. Andersen

There are no affiliations available

Personalised recommendations