Stakes are high in improving quality of life in terminally ill children. Thus, it is not surprising that most of the interventional literature describes the gratification that comes from controlling intractable cancer pain. Although most children with cancer can find relief with appropriately managed opioids, the spread of tumor to the nerves can cause extraordinarily resistant pain. One series reported that about 3% of children dying of cancer had pain that was unmanageable with systemic opioids alonen It is for these children that regional techniques are most powerful. Choices include spinal or epidural analgesics, which may be administered as single injections or as infusions, and the percutaneous destruction of peripheral nerves, nerve plexuses, and nerve roots.
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