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Pediatric Oncology: Managing Pain at the End of Life

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Abstract

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Jennifer M. Snaman & Justin N. Baker

  2. Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Jennifer H. Ehrentraut

  3. Department of Pediatric Medicine, Division of Anesthesiology, MS 130, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Doralina L. Anghelescu

Authors
  1. Jennifer M. Snaman
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  2. Justin N. Baker
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  3. Jennifer H. Ehrentraut
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  4. Doralina L. Anghelescu
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Correspondence to Doralina L. Anghelescu.

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

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Snaman, J.M., Baker, J.N., Ehrentraut, J.H. et al. Pediatric Oncology: Managing Pain at the End of Life. Pediatr Drugs 18, 161–180 (2016). https://doi.org/10.1007/s40272-016-0168-2

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