The Pediatric Pain Management Team

The Pediatric Pain management program was established in December 2003, by an initiative from the King Hussein Cancer Center and the Canadian government fund with approval from the Canadian embassy.  The motivation behind this project was the provision of comfort and pain relief for patients with cancer beginning from the early stages of diagnosis. The program is run by a team of pediatric palliative care and pain management physicians and staff from the center. It includes: A pediatric hematologist/oncologist, a general pediatrician and a nurse coordinator.

Mission:

• Provide excellent pain control for all pediatric cancer patients and to improve the quality of life during and after therapy.

• Achieve a multidisciplinary approach and cooperation with the primary physicians and nurses, to guarantee pain control.

• Increase physical capabilities and activities of patients of  by controlling and regulating their pain.

• Relieve the physical and psychosocial symptoms associated with pain and optimizing individual and family functioning.

• Educate patients and caregivers about pain management, and continually reinforcing the development and application of this knowledge, to correct myths about pain medications.

• Establish a regional reference program for pain control.

 Services provided:

The team provides pain service through different settings, including:

• In patient care: daily morning and evening rounds on admitted patients to evaluate patients and provide pain management, including post-operative patient care.

• Drop-in pain consultations for patient evaluation and management.

• Out patient care: three clinics per week for regular follow up of patients on pain medications and new consultations referred by other teams.

• Telephone follow-ups to ensure patient compliance and response to treatment as well as education and answering patient and family concerns about home medications.

• Pain assessment and control for palliative care patients during home visits.

Management of pain in children

• Our program adopts internationally recognized methods of pain assessment, before choosing the appropriate medications.

• Clinical guidelines and drug policies where put in place by a medical team and approved by the associate director of medical affairs.

• Different methods used for pain assessment are made according to a patient’s age and mental status; these include:

Example: Faces for conscious cooperative children between the ages of 4-8 years

The following is a brief summary of the guidelines followed in choosing pain medication:

• For mild pain (based on a scale rate of 1-3/10) use paracetamol or NSAID (like Aspirin and ibuprofen) if not contraindicated.

• For moderate pain (rank of 2-6/10) start with weak opioid as tramadol or codeine.

• For sever pain (a rank of 7-10/10) use strong opioids as morphine, methadone, and fentanyl.

• The decision to choose the route of administration (PO, IV, patches, or PCA) is made by the physician.
   

Myths about pain management: 

• Pain is a punishment that should be tolerated.

• Pain is an evidence of disease progression and its end stages.

• Severe chronic pain can not be controlled.

• Opioids are addictive medications that must only be used in terminal patients.

• It is socially unacceptable to express pain.

• Infants and young children don't experience much pain.