Health Topics

Pain that happens when someone has cancer comes from three main places:

1. The tumor or leukemia itself can hurt by pushing on or harming bones, nerves, muscles or internal organs.
2. Treatments such as chemotherapy, radiation and surgery can be uncomfortable or lead to painful conditions.
3. Many diagnostic tests such as bone marrow biopsies and blood draws hurt.

Mucositis (myoo-koh-SY-tis) commonly causes pain. It happens when someone has received some types of chemotherapy and his/her white blood cell count drops to zero. The lining of the mouth and digestive system breaks down and ulcers form. This can be very painful. There is often diarrhea or vomiting as well.

Bone marrow transplant chemotherapy is often associated with the worst and longest bouts of mucositis. Eating and having bowel movements can be very uncomfortable, and strong pain medication is often needed to keep patients comfortable. As the white blood cell count returns to normal, the ulcers heal and the pain goes away. All this can take from a few days to a few weeks, depending on the situation.

There are many ways to treat cancer pain. Each patient is different, and the cancer or leukemia affects each person differently. Treatments can include the following:

• Mucositis is usually treated with opioid (OH-pee-oyd) medication (such as morphine), often with the use of a patient-controlled analgesia pump (PCA).
• If a child can eat or drink, usually medicine by mouth works well.
• If special types of pain from nerve or bone involvement is the problem, then medications are used that specially treat those types of pain.
• Sometimes things like radiation and nerve blocks or epidurals are needed.
• At Cincinnati Children's Hospital Medical Center, the Acute Pain Service is generally involved for complex pain.

Opioid medications are feared for their effect on breathing, but this is rarely a problem. What is a problem is constipation. Your child will probably take a medicine that helps keep the bowels moving normally. Let your child's doctor or nurse know if your child has not had a bowel movement in more than two days.
Other general side effects can include:

• Sleepiness
• Nausea
• Itching
• Dry mouth
• Dizziness
• Trouble urinating

Your child's doctor or nurse will check with you about these side effects. Please let them know if you think your child may be having a side effect from the medicines he/she takes.

• Be yourself. That's simple, but it's also difficult. Playing with children helps distract them from what is going on that is scary or unpleasant. Talking with children allows them to get things off their chest. They know they are sick, and kids as young as 4 years old have talked of dying; they're not being protected by having their questions avoided.
• Speak up for your child. You understand your child best. Help the doctors and nurses interpret what your child is feeling, so they can help your child feel less afraid and be more comfortable.

Planning ahead helps. As your child goes through treatment, ask your child's doctor or nurse what you can expect from the next step in treatment.

At Cincinnati Children's, you can have child life specialists, social workers, chaplains and psychologists get involved early. This can help take the stress off both you and your child.

Reducing stress and helping your child be relaxed and distracted can help cut down how much pain he/she experiences. Don't wait until things are falling apart. "Staying ahead" of pain makes taking care of it easier and more effective. Staying ahead of pain means giving treatment for pain before your child experiences the pain at its worst.

• If pain is not controlled
• If your child is too sleepy
• If your child is not making sense when he/she talks
• If your child experiences a lot of vomiting or itching, or has trouble urinating

• Pain, Pain, Go Away: Helping Children with Pain, a website created to help parents understand pain in children
• Making Cancer Less Painful, a handbook for parents