Introduction

All children with cancer undoubtedly will experience some pain during the course of their treatment. Children may experience many different types of pain from invasive procedures, the cumulative effects of toxic therapies, progressive disease, or psychological factors. The pain often is complex, with multiple sources comprising nociceptive and neuropathic components. In addition, several situational factors usually contribute to children's pain, distress, and disability. Thus, pain assessment is an integral component of diagnosis and pain management for all children with cancer. At diagnosis, we need a reliable evaluation of the sensory features of a child's pain and an understanding of the relevant psychosocial factors that can exacerbate pain and distress. Subsequent assessments of pain intensity enable us to determine when treatments are effective and to identify the children for whom they are most effective.

Pain assessment is a dynamic process that begins with a diagnostic examination and culminates with a clinical decision that a child's pain has improved sufficiently. The assessment tools or specific measures we use differ depending on our clinical objectives – to capture pertinent diagnostic information, to routinely monitor pain intensity during treatment, to document pain features and symptoms related to different types of cancer and different treatment protocols, and to assess whether psychosocial factors are exacerbating pain and distress. In this chapter, we recommend a practical approach to achieve these varied clinical objectives.