1. Children of all ages experience pain from cancer, not only from the disease itself, but also from the procedures and treatment associated with it.

2. Children with cancer should be cared for, if at all possible, in a medical setting which is childcentered, has personnel who are comfortable working with children, and has age-appropriate materials available to the child.

3. The experience of pain is also subjective and not necessarily related to the amount of tissue damage. The pain an individual experiences is the result of the interaction of that tissue damage with a number of individual variables and, as a result, there is no right amount of pain for a given injury; the right amount is the amount the patient reports.

4. Pain should be assessed systematically on a routine basis in all children with cancer.

5. Assessment techniques must account for the child's developmental level and personality style. Self-report scales, behavioral observations, and physiologic measures are often used. The child's complaint of pain must be believed.

6. A pain problem list should be a part of the child's medical record.

7. Anticancer therapy is an essential aspect of pain control in childhood cancer. Symptom control until these modalities are effective is essential, however.

8. The pain associated with initial diagnostic procedures should be treated aggressively pharmacologically. Interventions for subsequent procedures should be based on the child's response to the initial procedures, on the course of the illness, and on the parents' perceptions of the child's needs.

9. Behavioral approaches should be introduced early and considered throughout the illness.

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