Pain in children with spinal cord tumors

Pain in children is generally not accorded the same significance by allied health professionals as pain in adults. To some extent this relative neglect may be the result of a general belief that pain is less of a problem in the pediatric age-group. However, it is the author's experience that the management of pain in children with spinal cord tumors reveals the same significance as in adults. From 1970 to 1980, 54 cases of spinal cord tumor were reviewed at the Children's Memorial Hospital and analyzed for their 'verbal' and 'nonverbal' pain descriptions. There were 22 extradural tumors, 20 intradural extramedullary and 12 intramedullary tumors. The patients ranged in age from 5.5 months to 15 years. The patients were divided into two groups. Group I (18 children) were under 3 years of age, and group II (36 children) were over 3 years of age. In both these groups pain was the most common finding (78%), followed by motor weakness (76%), pathological reflexes (74%) and sensory change (50%). Group I has 27 pain expressions (1.5 pain complaints per patient) and group II had 59 pain expressions (1.6 complaints per patient). Thus, the children of group I and group II expressed a similar number of pain complaints. However, in group I the majority (74%) of pain expressions were 'non-verbal', while in group II, the majority (85%) of pain expressions were 'verbal'. 2 typical cases of children with spinal cord tumors whose pain evolved from infantile 'nonverbal' and 'verbal' pain description to adulthood pain descriptions are illustrated.