Inadequate management of pain is a significant problem in all aspects of pediatric care. In every clinical situation which has been studied, children's pain receives far less attention than that of adults.1 Nowhere is this situation more unfortunate, however, er, than in the management of pain associated with childhood cancer. Poorly controlled cancer pain validates the worst fears of parents and children that cancer is accompanied by inevitable and excruciating pain. Inadequate control of the pain associated with diagnostic procedures creates an anticipatory dread in the child of the next procedure and colors his or her attitudes toward the hospital and the staff providing care.

This unfortunate situation has arisen partly because physicians dealing with these most devastatating of childhood diseases have not had easy access to information on the control of this most feared symptom. The complexities associated with research in childhood pain (in general, difficulties of assessment and ethical constraints) have been compounded by the relative rarity of childhood cancer and have resulted in limited research activity or interest in the management of cancer pain in children. The available research is often published in journals not generally read by those who care for children with cancer. Major pediatric texts contain virtually no information on the management of the pain associated with childhood cancer.2 The limitations of the available literature have allowed the development of few guidelines within institutions and virtually none across institutions (Hickman et al. 1988. Unpublished manuscript). As a result, the relative importance of adequate management of pain as well as specific treatment regimens are left to the discretion of the individual pediatric providers, most of whom have minimal training in this area.

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