Management of paediatric procedure-related cancer pain

Paediatric malignancy is not always painful in its own right; however, young patients with cancer undergo numerous painful procedures for diagnosis, therapy and supportive care, including limbar puncture, bone marrow aspiration and biopsy. Children with cancer consider painful procedures to be the most difficult part of their illness and the frequent repetition of procedures does not desensitize them to the distress. This review provides a brief overview of the state of the art with regard to procedure-related pain in children, and presents some methods and strategies for assessing it and managing it effectively. The first section briefly identifies the dimensions of procedure-related pain and describes the most commonly used methods for its assessment. This followed by an examination of the pharmacological strategies for pain management, including local anaesthesia, conscious sedation and general anaesthesia. In the next section, psychological interventions for the management of procedure-related pain, such as preparation, cognitive– behavioural therapy and hypnosis, are reviewed. The review concludes with recommendations for clinical practice.