Patterns of pain management in pediatric oncology patients: Experience from a tertiary care center in Pakistan

Background Pain is one of the most distressing symptoms in children with malignancies, yet pediatric palliative care (PPC) services in low- and middle-income countries (LMICs) remain underdeveloped. In Pakistan, gaps in physician training, opioid underprescribing, and healthcare worker and parental misconceptions hinder effective pain management. Objective This study aimed to assess the prevalence, characteristics and approach to pain management in pediatric oncology patients, along with self-reported physician competency in a hospital in Pakistan where PPC services were initiated. Methods A prospective descriptive study was conducted over six months (January–June 2024) at the Department of Pediatric Hematology-Oncology, The Children's Hospital, Lahore. Children (0–18 years) with moderate to severe pain were enrolled. Pain was assessed using age-appropriate validated scales, while adequacy of pain management and physician knowledge were evaluated through chart reviews and structured surveys. Results Among 724 admitted patients, 390 (54%) reported pain. Of these, 78 (20%) patients had severe pain, while 140 (36%) patients and 172 (44%) patients reported moderate and mild pain, respectively. Of these, 80 patients were enrolled with moderate to severe pain. Median age was 6.5 years, and males predominated (61%). The most common sites of pain included headache (21%), generalized body ache (12.5%), and abdominal pain (10%). Paracetamol was the most frequently prescribed analgesic, followed by tramadol and morphine. Intravenous routes were preferred, and combination therapy was common. However, adherence to WHO pain management guidelines was low (12%). Physician surveys revealed poor familiarity with validated pain scales, opioid prescribing and standard procedures, and non-pharmacological techniques. Conclusion Pain is highly prevalent in pediatric oncology patients in Pakistan but remains inadequately managed due to poor assessment practices, underutilization of opioids, and lack of physician training. Strengthening PPC services through standardized protocols, healthcare worker and parental education, and improved access to essential analgesics is urgently needed to enhance the quality of life for children with cancer and their families.