Pain management of children with terminal cancer in the critical care unit

Cancer remains the number one cause of disease-related death in children and adolescents over 1 year of age in the United States, and terminal pediatric cancer pain can be one of the most challenging symptoms to treat effectively. Opioids remain the cornerstone to pain management at end of life. However, adjuvant multimodal pharmacological and nonpharmacological interventions are needed to optimize pain management and to address total pain. Total pain is the concept that pain is experienced on many levels that interact and affect each other. These levels include physical, psychological, social, and spiritual. To be most effective in pain management, a comprehensive understanding of the types of pain and pathophysiology of pain experienced in the population is needed. In addition, the care plan should align with the goals and values of the patient and his/her family. Through comprehensive assessment of symptoms and clinical data, implementation of a stepwise procedure for pain treatment, and frequent reassessment to adjust medications, effective pain management can be achieved in virtually all children with terminal cancer in the intensive care unit (ICU).