Clinical practice guidelines including evidence-based recommendations for the management of pain and distress in children with cancer undergoing needle-related procedures were developed by an international, interdisciplinary team of clinicians and researchers and published in the European Journal of Cancer.

With the development of intensive treatment approaches, the survival rate for children with cancer has increased dramatically over the last 4 decades. Nevertheless, many of these treatments involve long courses and multiple adverse effects, including pain associated with needle-related procedures, such as lumbar puncture, bone marrow aspiration, bone and organ biopsies, and procedures for accessing the venous system.

“It is increasingly acknowledged that children are at risk of long-term sequelae from inadequate pain management during needle procedures, for example, increased levels of anxiety and noncompliance with care,” the authors of these guidelines stated.

Continue Reading

Related Articles

Key elements of these guidelines included recommendations for the following:

  • Recommendations for any needle procedures include use of topical anesthetics, hypnosis, active distraction (eg, active participation in an activity), passive distraction (eg, music), and a combination of psychological and pharmacological interventions.
  • Deep sedation/general anesthesia is recommended in the setting of lumbar puncture and for all patients undergoing major procedures.

The guideline authors stated that “it is critical that clinicians recognize the great between-patient variability in the severity of procedural pain and distress. Therefore, tailoring our recommendations to the individual child is of utmost importance.”

They further added that “this approach will result in improved care for children with cancer undergoing painful procedures, thereby reducing suffering and potentially enhancing health-related quality of life.”


Loeffen EAH, Mulder RL, Font-Gonzalez A, et al. Reducing pain and distress related to needle procedures in children with cancer: a clinical practice guideline. Eur J Cancer. 2020;131:53-67.