Cancer and its treatment causes discomfort on many levels, but controlling pain can speed recovery for children battling the disease, say pain management experts at St. Jude Children's Research Hospital.

Tumors press on nerves, bones and organs; radiation can damage the skin and mucus membranes; and chemotherapy agents can inflict harsh side effects. Additionally, acute pain increases a patient's heart and respiratory rates, metabolism, blood pressure and stress hormones. Children who are hurting need more oxygen. They have trouble participating in physical therapy and also experience more depression, anger and insomnia.

In the past, medical professionals treated pain almost as an afterthought after all, eradicating disease was the primary goal. As childhood cancer cure rates increased, clinicians recognized the need to alleviate suffering. By controlling pain, health care workers could advance recovery.

"Chronic pain influences the immune system, so patients don't heal as well. Research also shows that patients don't breathe as well when in pain, causing a higher risk of pulmonary complications after surgery," said Doralina Anghelescu, M.D., Anesthesiology Division at St. Jude. "Patients in pain don't eat as well or sleep as well either. Pain management benefits the whole body."

"The more parents know about pain, the better they will be able to help their child," Anghelescu said. "It is important for them to understand the kind of pain the child is having, what influences the pain and the best way to cope with the pain."


When assisting a child in pain, parents should consider the following tips:

-- Parents know their child better than anyone, so it's important to tell the doctor or nurse if the child is acting differently than normal. Parents should talk to their children about what they are feeling and thinking.

-- Parents should inform the child about what is happening, if he or she wants to know about it.

-- Parents should not say "This won't hurt at all." It's important to acknowledge the pain and not minimize or deny it.

-- Parents can make physical contact with their child by holding hands or giving hugs.

-- If possible, parents should remain with their child until the pain is controlled.

-- Parents can talk about the positive steps that are being taken to reduce pain. Parents can remind their child that the doctors and nurses will reduce the pain as much as possible.

-- Parents should try to keep their own anxiety under control and remain calm. Parents should not show negative cues such as gasping, flinching and cringing.

-- Parents should support the child's way of coping. Children can employ techniques such as deep breathing for relaxation; counting, singing or watching television for distraction; or reframing thoughts by evaluating negative ideas and images and replacing them with more positive ones. ("I'm strong. I can do this. I've had similar pain, and it got better.")

-- Parents should not scold or punish their child for not cooperating.

-- Parents should avoid helping to hold their child down during a procedure. Instead, they can hold their child's hand or offer ways to distract from the procedure.

"These techniques may not be a substitute for pain medication, but they can help the pain medicines work better," Anghelescu said. "Emotions can influence the amount of pain, and attitudes from other people play a role. It is important for parents to be careful not to reinforce negative thoughts, beliefs and emotions."