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Pain in Children With Cancer

Prevalence, Characteristics, and Parent Management

Tutelman, Perri R. BHSc (Hons)*,†; Chambers, Christine T. PhD*,†,‡; Stinson, Jennifer N. PhD§,∥,¶,#; Parker, Jennifer A. PhD; Fernandez, Conrad V. MD‡,**; Witteman, Holly O. PhD††,‡‡,§§; Nathan, Paul C. MD, MSc∥,∥∥,¶¶; Barwick, Melanie PhD∥,¶,##; Campbell, Fiona MD∥,#; Jibb, Lindsay A. PhD***; Irwin, Karen†††

doi: 10.1097/AJP.0000000000000531
Original Articles

Objectives: Pain is a common and distressing symptom of pediatric cancer, as reported by both children and their parents. Increasingly, children with cancer are cared for as outpatients, yet little is known about how parents manage their cancer-related pain. The aim of the current study was to examine pain prevalence and characteristics, and the pharmacological, physical, and psychological pain management strategies used by parents to manage their child’s cancer pain.

Materials and Methods: In total, 230 parents and caregivers (89% mothers) of children (mean age=8.93 y, SD=4.50) with cancer currently in treatment or who are survivors completed an online survey about their child’s pain in the preceding month.

Results: Results indicated that children with cancer who were on active treatment and who were posttreatment experienced clinically significant levels of pain. Parents reported using more physical and psychological strategies than pharmacological strategies to manage their child’s pain. The most frequently used physical/psychological strategy was distraction and acetaminophen was the most frequently administered pain medication. Parents’ confidence in managing their child’s pain was inversely associated with both how much pain they perceived their child had, and also whether they had given any pain medication.

Discussion: The results of this study suggest that despite parents’ use of pain management strategies, management of cancer-related pain continues to be a problem for children during treatment and into survivorship.

Departments of *Psychology and Neuroscience

Pediatrics, Dalhousie University

Centre for Pediatric Pain Research

**Division of Pediatric Haematology/Oncology, IWK Health Centre Halifax, Nova Scotia

§Faculty of Nursing

Faculty of Medicine

¶¶Institute of Health and Policy Management and Evaluation

##Dalla Lana School of Public Health, University of Toronto

Research Institute

#Department of Anesthesia and Pain Medicine

∥∥Division of Haematology/Oncology, The Hospital for Sick Children Toronto, Ontario

††Department of Family and Emergency Medicine

‡‡Office of Education and Professional Development, Laval University

§§Research Centre of the CHU de Québec-Université Laval Quebec, Quebec

***School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa

†††Cancer Knowledge Network Milton, Ontario, Canada

Supported by a grant from the Canadian Cancer Society Research Institute (#703699), Toronto, Ontario, Canada. P.R.T. was supported by a Vanier Canada Graduate Scholarship. She is a trainee member of Pain in Child Health, a Strategic Training Initiative in Health Research of the Canadian Institutes of Health Research, Toronto, Ontario, Canada and the Beatrice Hunter Cancer Research Institute Cancer Research Training Program, Halifax, Nova Scotia, Canada. H.O.W. is supported by a Research Scholar Junior 1 career award from the Fonds de recherche du Québec—Santé, Montreal, Quebec, Canada. C.T.C. is the Canada Research Chair (Tier 1) in Children’s Pain. The remaining authors declare no conflict of interest.

Reprints: Perri R. Tutelman, BHSc (Hons), Centre for Pediatric Pain Research, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia, Canada, B3K 6R8 (e-mail:

Received March 13, 2017

Received in revised form May 13, 2017

Accepted June 16, 2017

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