Pain

The purpose of this section is to give you the knowledge you need to help your child: how you can recognise pain, some information about different types of pain and what you and your nurses and doctors can do to try to relieve pain.

Everyone knows what pain is, everyone has experienced pain at various times in their lives but it can be very frightening. Fear makes pain worse, so it is helpful if you can remain calm and confident as this will help your child to remain calm and feel in control.

It is quite common for a child to feel pain at this stage in their illness, but it is sometimes difficult to know if 
a child is in pain.

How do you know if your child is in pain?

Your child may be able to tell you about their pain but some children, particularly younger ones, can’t really describe how they feel and you need to pick up clues from how they behave:

  • They may be unable to settle to any activity or appear restless
  • They may just sit still or sleep in one position and not want to move around
  • They may become distressed if you carry or move them
  • They may be unable to sleep properly.

Remember, as parents, you know your child best and if you think your child is in pain, please tell your nurse or doctor.

What can your nurse or doctor do to help?

  • They try to understand the cause and type of pain and prescribe the best medication for the type of pain your child has
  • They may use different types of medication which often act better together than on their own
  • They will review your child on a regular basis and will change the medication as your child’s condition changes
  • They will explain exactly what you should give and when

Pain tends to come in waves and it may not be possible to control pain completely, but this is the aim:

  • To give enough regular medication to keep your child free of pain for most of the time, and to take the edge off the waves of pain
  • To give you additional medicine that you can use for the peaks of pain

What treatment can your child have?

Pain relieving medicines

There is a wide range of pain relieving medication to manage mild to moderate to severe pain – these will usually be prescribed as regular and ‘breakthrough’ doses

Regular medication:

  • Give it on time
  • Give it even if your child has no pain
  • Give it on time even if you have recently given a dose of ‘breakthrough’ medicine

'Breakthrough’ or ‘as-required’ medication:

  • Even with regular medication, your child may still experience episodes of pain: you will be given a supply of quick-acting medication to use for these episodes
  • Encourage your child to tell you if they are uncomfortable or in pain
  • Watch out for ‘silent’ pain – moving often brings on pain, some children are too frightened to move
  • You may use breakthrough medication before any activity which you know will be painful, e.g. moving
  • Give this in addition to the regular medication
  • Keep a record of these episodes of pain and of the medication you have given and tell your nurse or doctor
  • Your nurse or doctor will review how much pain relieving medication your child needs on a regular basis
  • It takes a couple of days to see the effects of any increases in regular doses.

Side effects of pain relieving medicines

  • Constipation: Morphine and its related medicines slow down the bowels – it is nearly always necessary to give additional medication for this (see page 33)
  • Nausea: children may feel nauseated (sick) during the first day or two of Morphine but this will usually wear off (see page 17)
  • Sleepiness: your child may be a bit more sleepy when the dose of Morphine is increased but this should wear off after a day or so – if they remain very sleepy, you should tell your nurse or doctor
  • Itch: Morphine and related medicines may cause itchy skin, this should get better within a couple of days, if it doesn’t, tell your nurse or doctor: they may need to change the medication
  • Urinary Retention: very occasionally Morphine may make it more difficult for your child to pass urine. If you are concerned please ask your nurse or doctor about this

Additional medicines

These are different types of pain, for some of them pain relieving medicines work best when combined with other medication:

‘Bone pain’ and ‘soft tissue pain’ (caused by a tumour in bone or muscle etc)

  • Non-steroidal anti-inflammatory medicines, e.g. Brufen, Diclofenac help by reducing inflammation and swelling
  • They should be taken regularly with or after meals or a snack

‘Nerve pain’ (caused by a tumour pressing on nerves)

  • Some anti-epileptic and anti-depressant medicines can help ‘nerve pain’
  • They should be taken regularly
  • For some medicines, the dose may need to build up over a week or so
  • It may take 7-10 days for these medicines to achieve their best effect, so keep going with them
  • Steroids are sometimes prescribed to reduce swelling and pain, when a tumour is pressing on or damaging a nerve, but only for a limited time because of side effects

‘Muscle spasms’ (cramp-like pains in muscles)

  • Muscle-relaxing medicines can be prescribed for painful spasms

How can the medicines be given?

  • Tablets and liquids may be easy if your child can swallow and keep them down
  • Patches: some pain relieving medicines are available as a patch which goes on the skin – like a plaster – and releases the medicine gradually
  • Lozenge: some pain relieving medicines are available in lozenge form which can be rubbed inside the cheek, this works quickly and can be good for peaks of pain
  • ‘Buccal’ medicines: pain relieving medicines can also be given by syringe into the mouth inside the cheek for a quick effect. These do not need to be swallowed to be effective – they go straight into the blood stream.
  • Continuous pump; pain relief can be given continuously through a subcutaneous cannula (this goes just under the skin) or may be given via your child’s central line
  • Suppositories can occasionally be used

What else can you do to help?

A number of physical aids and psychological techniques can work alongside medication to make your child more comfortable.

Physical aids

Pressure relieving mattress

  • If your child finds it difficult to move in bed, pressure areas may become sore and add to their discomfort
  • Your nursing team may be able to arrange a pressure relieving mattress and a hospital bed for your home

Use of heat and cold

  • Hot or cold compresses may take the edge off pain while the medicines have a chance to work

TENS Machine

  • This is a small, lightweight, battery operated device with adhesive patches which gently stimulates nerve endings to block painful impulses and helps muscles to relax
  • The device is operated by the child so it gives them some control

Relaxation and other techniques

Relaxation and distraction can often help pain and other symptoms; you can ask your nursing team or 
play specialist for more information.

  • See the section on relaxation techniques
  • Massage may help
  • It may be possible to arrange art or music therapy

Emotional Pain

Children can suffer psychologically as well as physically, this sometimes goes along with physical pain but it can happen on its own. Here are some ways in which your child may express that they are hurting:

  • They may become withdrawn, tearful or inconsolable
  • They may refuse to talk to anyone, or be angry at those around them
  • They may be unable to concentrate
  • They may complain of tiredness or bad dreams

What can be done to help?

  • Allow your child opportunities to explore and express any feelings
  • There is a range of professionals who may be able to help