Pain and Symptom Control in Terminally Ill Children

Dying children stir even the hardest hearts. But in a society in which benevolent groups arrange visits with sports stars for children with cancer, it is surprising that physical pain in the terminally ill is still so poorly managed. Pain relief for children with terminal illness lags behind palliative care for adults.20, 75, 116 Even childhood cancer, a disease the medical community associates with pain, has not benefitted from many innovative pain-management techniques commonly provided to adult patients. Other terminal illnesses associated with pain, such as AIDS and cystic fibrosis, receive even less attention.46, 87 In these patients, pain is often poorly assessed, treatment plans are poorly formulated, and the reluctance to treat pain with opioids is extraordinary.117 Even when opioids are used appropriately in terminally ill children, some conditions respond poorly to them. In these patients, adjuvant drugs, such as anticonvulsants, antiarrhythmics, and antidepressants, may be necessary to treat pain. Finally, even patients optimally managed with opioids and adjuvants sometimes fail to achieve comfort. In these patients, techniques borrowed from adult pain medicine, such as chronic epidural and intrathecal catheters and neurolytic nerve blockade, make the greatest contribution.6, 100, 101