How Can We Control Pain?

Pain lets us know something is wrong. Once we know what is causing the pain, it serves no useful purpose and should be eliminated. It is not "weak" to have help with pain. In fact, sometimes being "strong", or not talking about pain, prevents doctors and nurses from knowing about a problem. Children with cancer should be protected from pain as much as possible. Pain takes energy that is better used to fight disease and to do more normal things like playing.

There are many ways we can help control pain. These are described in the next sections of the book. But first, there are three important principles for treating pain:

1. TREAT PAIN BEFORE IT OCCURS

We know ahead of time that some things will be painful. In these cases, it is better to treat or prevent the pain before it begins. "An ounce of prevention is worth a pound of cure". For example, "freezing" the skin with a local anaesthetic will help prevent needle pain. Giving pain medicine regularly, around the clock, is better than giving it only when it is needed. (The latter is sometimes called "giving medicine p-r-n"). Giving medicine regularly prevents pain from coming back before the next dose and helps keep the child pain-free.

2. PLAN AND COMBINE PAINFUL PROCEDURES

When possible, painful procedures should be combined to reduce their effect on the child. For example, if a child is to have conscious sedation (see the section on Pain Medications) for a bone marrow aspiration, other painful procedures can be done at the same time. If possible, the child should also know when a procedure is to be done. If a child knows he or she is to have a bone marrow aspiration at 2:00 pm, there is no need to worry about it until then. For most children, it is more of a worry not to know when a procedure will be done or to have the time changed without being told.

3. USE MULTIPLE TREATMENTS AGAINST PAIN

Pain control methods fall under three general headings: psychological methods, methods using medications, and physical methods. The following sections describe choices within each method.

Because pain is so complex, it is best stopped by using several methods at the same time. For example, a child having a lumbar puncture will find it helpful to combine relaxation techniques with a local anaesthetic. A later section of this book (Help with Painful Procedures) describes specific methods that are useful for procedures your child may have.