What you can do to help your child in pain About pain A child with cancer or other diseases will likely have pain at times. The pain can keep him or her from being active, from sleeping well, from enjoying family and friends, and even from eating. Pain can also make him or her feel afraid or depressed. When your child hurts, it is important that he or she feels a sense of control over the pain. Fortunately, the more you know about pain, the better you will be able to help your child. It is important for you to understand the kind of pain your child is having, what influences the pain and the best way to help him or her cope with the pain. Rather than allowing your child to feel helpless, you can help him or her learn skills that will help reduce the pain. If your child is feeling pain, it is very important that you tell his or her doctor or nurse as soon as possible. With treatment, most pain can be reduced easily. What causes pain? Pain can have many different causes. Most cancer pain comes when a tumor presses on bones, nerves or body organs. Treatment of an illness can cause pain as well. Your child may also have pain that has nothing to do with his or her illness or its treatment. Like everyone else, he or she can get headaches, muscle strains, and other aches and pains. You should check with your child s doctor or nurse about what to do for your child for these everyday aches and pains before giving him or her additional medicines. Pain related to a procedure, treatment or tests such as IVs, injections and lumbar punctures (spinal taps). It is usually localized to the site of the procedure. If your child is having a procedure, such as the insertion of a needle into a vein, an injection or a lumbar puncture (spinal tap), ask your doctor or nurse about the use of numbing cream. Pain related to the cancer or its treatment. Pain from a tumor pushing on body parts can be reduced by using medications called analgesics. If your child needs to have surgery or if he or she has side effects from the chemotherapy or radiation therapy, your child s doctor or nurse will tell you which medications will work best for the type of pain your child is having. If your child describes his or her pain using terms such as tingling, shooting or like needles, his or her doctor may prescribe specific medicines to reduce pain involving the nerves. Assessing pain If your child is in pain, he or she may do one of the following: Complain of pain Cry, moan, be irritable or withdraw quietly Be restless or not want to move at all Page 1 of 5
Hold or guard the area of discomfort Not eat or drink as much as usual Have difficulties sleeping or sleeping too much to avoid the pain Your doctor and nurse will ask your child to tell how much he or she is hurting by using one of three methods: 1. The FACES pain scale: 0 2 4 6 8 10 No Hurt Hurts Hurts Hurts Hurts Hurts Little Bit Little More Even More Whole Lot Worst From Wong D. L., Hockenberry-Eaton, M., Wilson D., Winkel stein M.L., Schwartz P.: Wong s Essentials of Pediatric Nursing, ed. 6, St. Louis, 2001, p.l301. Copyrighted by Mosby, Inc. Reprinted by permission. 2. If your child is old enough, he or she may be asked to rate the pain from 0 to 10 without the FACES pain scale. 3. If your child is too young to rate the pain, your doctor or nurse will use a scale (called the FLACC) as they watch for behaviors that might mean your child is in pain. You know your child better than anyone, so tell the doctor or nurse if your child is acting differently than normal. Talk to your child about what he or she is feeling and thinking. Your child s thoughts about what he or she hears are important. ( I was told this will hurt the last time so it will hurt this time. ) The beliefs your child has learned influence what he or she tells you about the pain. (e.g., I m a big boy and big boys don t cry! ) Emotions influence the amount of pain. (e.g., Where s my Mommy? I m scared without my Mommy! ) Attitudes from other people play a role. (e.g., It s expected to hurt at least some. ) Be careful not to reinforce negative thoughts, beliefs, emotions and attitudes. Some helpful responses to your child s pain are to: Inform your child about what is happening, if he or she wants to know about it. Acknowledge the pain; do not minimize or deny it. Page 2 of 5
Make physical contact with your child. Hold his or her hand or give him or her a hug. If possible, remain with your child until the pain is controlled. Talk about the positive steps that are being taken to reduce the pain. Help your child do something to make the pain go away. Keep your own anxiety under control and remain calm. Support your child s way of coping. Treating cancer pain Pain treatments work differently for different people. You need to fully understand how your child s medications should be taken and that you follow those directions very carefully. Because some actions can lead to serious or even dangerous results: Do not give him or her more medicine than is prescribed by the doctor; Do not give it to him or her more frequently than is prescribed; Do not stop it abruptly without your doctor s advice; Do not crush pills that cannot be crushed, cut or chewed; and Do not add any other medications or herbal remedies without first talking to the doctor. Your child may not get the pain relief he or she needs from just using medicines. Surgery, radiation therapy and other treatments can be used to give even more pain relief. It is very important that you tell your child s doctor or nurse how he or she feels and whether or not the treatments are helping. Sometimes patients worry that their doctor or nurse will think that they are complaining, but this is not true. Your child s doctor and nurse need this information so they can find the right pain medicine and treatments for your child. The chart on page 4 shows some things to help make the pain go away. These techniques may not be a substitute for pain medication, but they can help the pain medicines work better. Common questions parents ask Do infants and children feel pain? Yes. The belief that they do not experience pain is not true. Even though they are unable to talk about it, infants and children do feel pain. Therefore, they need to be treated with the same care and concern given to adults in pain. Do children always admit to having pain? No. If children are experiencing pain they may be afraid to tell someone about it. Page 3 of 5
Technique How it Works Examples Relaxation Distraction Reframing/ Thought Stopping Imagery/ Hypnosis Modeling Heat* Cold* Massage* Exercise* Relieves anxiety Reduces muscle tightness Good for episodes of brief and/or severe pain Focus attention on something other than pain Evaluate negative thoughts and images and replace them with more positive ones Concentrate on the image of a positive experience or situation or a favorite memory Learn from someone else s successes Increases blood flow Helps pain from inflammation, swelling, acute injury, procedural pain Increases flow of body fluids Gently stretches tissues Helps tissue pain and edema Strengthens muscles Loosens stiff joints Increases blood flow Helps with most types of pain * Consult your doctor or nurse before using these techniques. Deep breathing (try soap bubbles or party blowers) Muscle relaxation Meditation Soothing music of nature sounds Counting, singing, praying Watching television or movies (especially comedies), talking to family, listening to someone read, playing video games I ve had similar pain, and it got better I m strong. I can do this Ask your child to be very specific in describing the details of the imagined experience (colors, sounds, smells, tastes, feelings) Have your child observe another child managing hi or her pain and anxiety by staying calm and talking through his or her coping techniques Warm baths or towels. Consult your physician before using heating pads. Ice packs, crushed ice in a towel Use gliding strokes over the skin Do not push solid parts under the skin or massage directly on the painful area Walking, biking Page 4 of 5
Can children really tell us if the treatment of their pain is working well? Yes. Children are the experts of their own pain. Even very young children can tell us when they are in pain and how much they are hurting. Will my child become addicted to the pain medication? No, except in very rare cases. Some parents and children worry about becoming addicted or hooked if they take pain medications. Drug addiction means that a person is taking a drug to get a mental high instead of relief from real pain. However, patients with cancer take pain medicine to relieve pain so that they can be as active and comfortable as possible. The truth is addiction is very rare when medicine is taken for pain control. If my child takes large doses of pain medicine now, will it stop working later when he really needs it? No, the medicine will not stop working. Sometimes, however, your child s body might get used to the medicine, which is called tolerance. If this happens, your child will need to be prescribed more pain medicines, but this will not cause any harm to him or her. Can t my child just tough it out? What about the old saying, No pain, no gain? It is unacceptable for a child ever to be in pain. Being sick and having to undergo treatment is difficult and scary enough for anyone. Untreated pain does not make them tough or help them to build character. What can I do to help my child with his pain? Be calm and have a positive attitude that his or her doctors and nurses will reduce the pain as much as possible. However, you should not say this won t hurt at all. Control your own anxiety and do not show negative cues such as gasping, flinching and cringing. Do not scold or punish your child for not cooperating. Avoid helping to hold your child down during a procedure. Instead, hold his or her hand or offer ways to distract him or her from the procedure. Can I stop giving the pain medicine to my child if his pain goes away? No, you need to check with your child s medical team. Gradually stopping pain medicines helps avoid side effects. The slow decrease is important because the body has become used to the medicine much like your body gets used to nicotine or caffeine. Gradually stopping the medicine will allow time for the body to get used to not having the medicine. It does not mean your child is addicted to the medicine. Questions? If you have any questions or concerns, please talk with your child s doctor or nurse. Adapted with permission from St. Jude Children s Research Hospital. Revised 9/03 Page 5 of 5 UC Davis Cancer Center 12/06