Pharmacologic and psychologic interventions for procedural pain

Pharmacological solutions for reducing pain and distress in children during invasive procedures are not as effective as combined pharmacological and psychological tactics. The combined effort reduced child and parent distress more effectively than the use of drugs alone, but the use of drugs was, in turn, more effective than no particular intervention at all. Younger children were more distressed than older children and required more considered attention.
Objective. This study evaluated a combined pharmacologic and psychologic intervention (combined intervention, CI) relative to a pharmacologic-only (PO) intervention in reducing child distress during invasive procedures in childhood leukemia. Predictors of child distress included age, group (CI, PO), and procedural variables (medications and doses, technical difficulty, number of needles required). Methodology. This was a randomized, controlled prospective study that compared the PO (n = 45) and CI arms (n = 47), at 1, 6, and [is greater than] 12 months after diagnosis. A cross-sectional control group consisted of parents of 70 patients in first remission before the prospective study. Parent questionnaires, staff and parent ratings, and data on medications administered, technical difficulty of the procedure, and needle insertions were obtained for each procedure. This article reports on the final data point for the project ([is greater than] 12 months). Results. Mothers and nurses reported lower levels of child distress in the CI than the PO group. The CI and PO groups showed lower levels of child and parent distress than the cross-sectional control group. Distress decreased throughout the time, and child age was inversely related to distress (younger children had more distress) regardless of group. Child distress was associated with staff perceptions of the technical difficulty of the procedure and with child age, but not with medications administered. Conclusions. The data showed that pharmacologic and psychologic interventions for procedural distress were effective in reducing child and parent distress and support integration of the two approaches. Younger children experienced more distress and warranted additional consideration. Staff perceptions of the technical difficulty of procedures were complex and potentially helpful in designing intervention protocols. Pediatrics 1998;102: 59-66; pediatric oncology, pain, procedures, intervention. ABBREVIATIONS. LP, lumbar puncture; BMA, bone marrow aspirate; GA, general anesthesia; APPO, Analgesia Protocol for Procedures in Oncology; PO, pharmacologic-only; CI combined intervention; CC, cross-sectional control; ANLL, acute nonlymphocytic leukemia; PPQ, Perception of Procedures Questionnaire; POQOLS, Pediatric Oncology Quality of Life Scale.
Reducing the pain and anxiety associated with invasive procedures such as lumbar punctures and bone marrow aspirates (BMAs) in the diagnosis and treatment of childhood cancer is a widely shared [...]