Report of the Subcommittee on Disease-Related Pain in Childhood Cancer

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Abstract
OVERVIEW: CANCER PAIN SYNDROMES IN CHILDREN Pain due to cancer may be caused by tumor infiltration or invasion of bone, soft tissues, viscera, and nerves. Disease-related pain is especially common on with metastatic cancer, although there is no predictable relationship between the tumor burden and the intensity of pain. Conversely, exacerbation of pain or dramatic increase in analgesic requirements is often a clue to the occurrence of disease progression. As with all forms of pain, management of disease-related pain requires a thorough investigation and the establishment of specific diagnoses. There has been detailed study of cancer pain syndromes in adults, and preliminary efforts have been made in this regard in pediatric cancer.10 Specific diagnosis and etiology for the pain are important to document, because more effective systemic or local therapies may be applied. This assessment must be broad-based, and it must take into consideration both disease mechanisms in the narrow sense as well as psychosocial factors which modify the experience of pain. MANAGEMENT APPROACH FOR DISEASE-RELATED PAIN In adults, a stepwise approach to the management of the pain associated with cancer using the "analgesic ladder" has been useful. This approach should not be regarded as a " cookbook" to be followed by rote; specific and symptomatic management of pain must be tailored to the needs and wishes of the individual patient. An algorithm for management of pain is shown in Figure 2. Effectiveness of Modalities of Cancer Treatment in Pain Relief A primary means for controlling pain due to cancer lies in specific cancer treatments, especially chemotherapy and radiation.

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