Understanding Pediatric Cancer Pain

hen Relieving Suffering Is Also Part of the Treatment

The Pain That Must Never Be Normalized

Speaking about pain in pediatric oncology means addressing an experience that goes far beyond the physical. For Dr. Karla Itzel Gutiérrez Riveroll, cancer-related pain is not just another symptom, it is a constant reminder of the battle a child and their family are facing.

“Chronic pain in children can arise from various causes and is often more stable and manageable. Cancer pain, however, is directly linked to the disease and its treatments. It changes as the illness progresses and carries a much heavier emotional burden.”

Unlike other types of chronic pain, the emotional component here is inseparable. It is not only the body that hurts, it is the fear, the uncertainty, the daily struggle. That is why treatment must go beyond prescriptions. It requires a humane, comprehensive, and dignified approach.

The Third Most Common Symptom in Pediatric Cancer

After fatigue and loss of appetite, pain is the third most common symptom among cancer patients.

Tumors may compress nerves, organs, or bones. Surgery, chemotherapy, and radiation therapy can also generate pain. And unlike other chronic pain conditions, cancer pain evolves with disease progression.

Recognizing and treating it comprehensively is not optional, it is essential to restoring quality of life and hope.

Prevalence and Impact: Numbers We Cannot Ignore

Globally, between 50% and 70% of children with cancer experience pain at some point during treatment. In Latin America, studies show similar rates, though pain often remains under-recognized and undertreated.

By age group:

• Ages 3–6: 25–40% experience moderate to severe pain during hospitalization.
• Ages 7–12: prevalence increases to 50–60%.
• Ages 13–17: rates may reach 60–70%, especially in advanced stages.

These figures remind us of one fundamental truth: pain must never be normalized. It can—and must—be treated.

When Pain Goes Untreated

The consequences extend beyond the physical.

• Children stop playing.
• Sleep becomes disrupted.
• School participation declines.
• Anxiety and fear increase.

Medically, uncontrolled pain can make treatment more difficult, reduce energy levels, and even delay recovery.

This is where pediatric interventional pain management plays a critical role—offering advanced options when pharmacological therapy alone is insufficient.

There are always alternatives.

Clinical Management: More Tools, More Hope

Modern management is comprehensive and personalized.

It includes:

• A stepwise use of analgesics—from basic medications to opioids when necessary.
• Interventional techniques such as nerve blocks and regional infusions.
• Implantable intrathecal morphine pumps in selected cases.
• Psychological support.
• Physical rehabilitation.
• Complementary therapies such as music therapy and guided relaxation.

At Hospital ABC, specialized teams even perform preventive interventional techniques during surgery. Using fluoroscopy, ultrasound, or CT guidance, procedures are performed to reduce the risk of chronic pain development.

In certain cases, sympathetic plexus ablation can “deactivate” tumor-related sensory pathways before surgery, lowering the likelihood of treatment-resistant pain following chemotherapy or radiation.

Implantable intrathecal pumps—indicated for children weighing over 20 kg with a life expectancy greater than two years—can last up to nine years, providing a safe option for children with longer survival trajectories.

Today, we have more tools than ever.

Integrative Care: Where Science and Humanity Meet

Pain management does not rely solely on medication.

Mindfulness, conscious movement, and healing environments can significantly reduce anxiety and restore a sense of control.

“We can help reprogram a child’s brain after multiple painful stimuli.”

These approaches do not replace science—they enhance it. They allow medications to work more effectively and make procedures more tolerable.

They serve as a bridge between medicine and humanity.

The Responsible Role of Wellness Spaces

Wellness centers can become valuable allies when working in coordination with oncology teams.

In safe, medically supervised environments, practices such as breathing exercises, relaxation, and calm therapeutic spaces can improve sleep, reduce anxiety, and provide emotional relief.

Collaboration is key.

Breaking the Myths

Several misconceptions continue to limit adequate treatment:

• “Pain is inevitable.”
• “Children must endure it.”
• “Opioids always cause addiction.”
• “Talking about pain distracts from cancer treatment.”

None of these are true.

When used appropriately and under supervision, opioids are safe and essential. Moreover, pain management does not stop at medications. In some cases, interventional techniques are preventive—reducing opioid consumption and preventing severe chronic pain.

Pain must never be normalized.

Why Does Undertreatment Persist?

Despite advances, some children still receive insufficient pain control due to:

• Underestimation of pediatric pain.
• Fear of opioid use.
• Limited access to pediatric pain specialists.
• Lack of awareness about advanced interventional techniques.

Pain management must be comprehensive, stepwise, and, when necessary, interventional.

Looking Ahead

The future of pediatric cancer pain management is evolving rapidly.

Research is advancing in:

• New pediatric pain assessment tools that measure emotional and functional impact—not just intensity.
• More precise and safer interventional techniques guided by imaging.
• Smart intrathecal pumps capable of adjusting medication delivery in real time.
• Evidence-based complementary therapies that help reduce anxiety and improve quality of life.

The future is more humane, more technological, and more precise.

World Cancer Month: A Shared Responsibility

“No child should live with preventable pain.”

Relieving suffering is a shared responsibility among physicians, families, and society.

For parents: pain should never be normalized.
For healthcare professionals: use every available tool.
For children: their childhood deserves dignity, joy, and freedom from unnecessary suffering.