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Pediatric Cancer Pain Management: Strategies and Interventions

Learn about pediatric cancer pain management, including assessment, treatment options, barriers, and key points for effective care. Understand biobehavioral therapies, pain medications, and goals of treatment.

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Pediatric Cancer Pain Management: Strategies and Interventions

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  1. Cancer pain management • Pediatric Pain Resource Nurse Curriculum

  2. Pediatric cancer: prevalence • Source: American Cancer Society, Cancer Facts and Figures (2017) • *Includes: osteosarcoma and Ewing sarcoma

  3. ? Billy • What is your response? • What additional questions might you ask Billy and his mother to obtain a complete initial pain assessment and history? • Billy is a 4-year-old who presents to the pediatrician with his mother. He has refused to walk for the last 2 days and has complained of leg pain for the last week with fatigue and dyspnea with mild exertion. • Lab results initially revealed anemia and decreased platelets. Blood pathology revealed Billy has B cell ALL.

  4. Pediatric Cancer Pain Management

  5. ? Billy • What is your response? • What can be done immediately to relieve Billy’s leg pain? • What pain medications would be indicated for persistent pain?

  6. Pharmacological Management of Cancer Pain • Treatments • Chemotherapy • Biotherapy • Radiation • Non-opioids • Acetaminophen • Nonsteroidal anti-inflammatory drugs • Opioids • Adjuvants • Corticosteroids • Off-label use of cannabinoids +

  7. Goals of Cancer Pain Treatment • Prevention • Reduce pain that can not be relieved • Prevent/manage adverse effects associated with cancer and pain treatment • Promote patient safety and function • Enhance quality of life

  8. Barriers to Cancer Pain Relief • Common barriers • Healthcare professionals • Expectations • Knowledge • Fear of Tolerance • Lack of Interdisciplinary cooperation • Patients and families • Most believe pain is an unavoidable • Assume treatment team would address • Reluctant to “complain” about pain • The healthcare system • Low priority • Few treatments approved by FDA for children • Lack of evidence/funding for research for most biobehavioral treatments.

  9. Billy • What biobehavioral therapies might be useful for Billy? • What education should be provided to Billy and his family? • What is your response?

  10. Billy • A week after completing the first cycle of chemotherapy, Billy refuses to put socks or shoes on. • How would you treat his peripheral neuropathic pain? • What is your response?

  11. Key Points • Cancer pain management • Consider the variety of causes of children’s cancer pain • Conduct a thorough pain assessment • Develop evidence-based, multimodal, interdisciplinary, individualized plans • Prevent or promptly treat adverse effects • Evaluate and modify treatment plan • Address existential distress • Educate • Lead organizational efforts to reduce barriers to optimal pain management

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