Pain and distress in the paediatric palliative care population can be very difficult to manage. Clinical scenarios range from the acute management of cancer-related pain at the end of life to the ongoing long-term support of children with complex multimodal pain related to progressive neurological conditions. Understanding the child’s underlying condition, possible causes of pain and their preferred mode of communication are important to the delivery of holistic care. Modification of environmental factors, basic care consideration and non-pharmacological measures have a large role to play, alongside conventional analgesics. Medication may also need to be delivered by novel routes such as transdermal patches, continuous subcutaneous infusion of multiple drugs or transmucosal breakthrough analgesic doses. Two cases are used to illustrate approaches to these clinical problems.
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Contributors EJH co-ordinated and edited the paper. KathB contributed her narrative account of caring for her son, during his palliative phase, she also reviewed the completed article. KarenB contributed to the sections on palliative care outreach nursing and also reviewed/proofread our work.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
Author note Dedicated to the memory of Jack Pierre Pixton, who taught us all a thing or two.