Management of paediatric procedure-related cancer pain

Abstract

Paediatric malignancy is not always painful in its own right; however, young patients with cancer undergo numerous painful procedures for diagnosis, therapy and supportive care, including limbar puncture, bone marrow aspiration and biopsy. Children with cancer consider painful procedures to be the most difficult part of their illness and the frequent repetition of procedures does not desensitize them to the distress. This review provides a brief overview of the state of the art with regard to procedure-related pain in children, and presents some methods and strategies for assessing it and managing it effectively. The first section briefly identifies the dimensions of procedure-related pain and describes the most commonly used methods for its assessment. This followed by an examination of the pharmacological strategies for pain management, including local anaesthesia, conscious sedation and general anaesthesia. In the next section, psychological interventions for the management of procedure-related pain, such as preparation, cognitive-behavioural therapy and hypnosis, are reviewed. The review concludes with recommendations for clinical practice.

Use of Complementary and Alternative Medical Interventions for the Management of Procedure-Related Pain, Anxiety, and Distress in Pediatric Oncology: An Integrative Review

“…None of the studies reported prior to 1996 included pharmacological interventions. Overall, 28% (9/32) of the studies reported use of pharmacological interventions in addition to the CAM intervention or used a pharmacological agent in at least one arm of the study; of note, 46% (6/13) of the studies reported during the most recent decade (1999–2009) included pharmacological interventions, reflecting the gradual adoption of more aggressive pharmacological management of procedure-related pain in children (Liossi, 1999). …”

“…Pain is a multifaceted experience that may result in adverse physiological, cognitive, emotional, and behavioral responses (Liossi, 1999). Pharmacological management in the form of local anesthetic agents, sedation, or general anesthesia may provide significant relief of procedural pain, anxiety, and distress (Doellman, 2003).…”

Hypnosis in cancer care

“…The person who learns hypnosis for management of pain or nausea and vomiting may apply their skills to lessen the distress of insomnia and anxiety, to address dysphagia for pills or to enhance their performance in their favourite sport. For a clinician, hypnosis is an opportunity to be inventive, spontaneous and playful and to build a stronger therapeutic relationship with a patient while providing symptom relief (Liossi, 1999).…”

“…The consistency of the findings and methodological considerations among the studies conducted so far indicates the usefulness of hypnosis as an effective intervention for helping children and adolescents to control the pain and anxiety associated with medical procedures (Liossi, 1999; and renders hypnosis as empirically validated intervention in procedurerelated pain management (Liossi, 2002) according to the criteria developed by Chambless and Hollon (1998) and endorsed by the American Psychological Association. The following three studies have made a critical contribution to the establishment of hypnosis as evidence based and are briefly described below.…”

Pratiques de l’hypnose chez l’enfant douloureux

“…Ses indications concernent : les troubles psychologiques, les troubles du comportement, les problèmes de l'apprentissage et de la performance... mais aussi d'autres problèmes pédiatriques comme les affections pulmonaires, les allergies, l'urticaire, les problèmes dermatologiques variés, les maux de tête, l'énurésie, la mucoviscidose, le diabète, la dysphagie, les désordres gastro-intestinaux, les troubles des fonctions immunitaires, la douleur, les nausées et vomissements en cours de chimiothérapie, les soins palliatifs... Dans le cadre de la douleur, plusieurs études ont montré l'efficacité de l'hypnose dans les soins des brûlés [21], pour les douleurs cancéreuses [10,14,24], les douleurs chroniques et récurrentes (comme les douleurs abdominales) [20], l'arthrose juvénile [22], les maux de tête [17], les pathologies respiratoires [1-3], etc.…”