Patients with cancer undergo painful procedures for diagnosis, therapy, and supportive care, including lumbar puncture, bone marrow aspiration, and biopsy. Although venipunctures, insertion of intravenous catheters, and intramuscular injections are less invasive, less painful procedures, their frequency and repetition become a major source of distress and apprehension. For aggressive treatment protocols, multiple invasive procedures may be performed weekly or daily. Children with cancer consider painful procedures to be the most difficult part of having cancer, and frequent repetition of procedures does not desensitize them to the distress (Fowler-Kerry, 1990, Weekes and Savedra, 1988). No published studies have focused on the reactions of adults to frequent and cumulative procedures, but some adults may be able to cope because of their greater cognitive ability and life experience in dealing with adversity and stress. Nevertheless, what is painful for a child or adolescent is also likely to be painful for an adult, especially when already stressed by the diagnosis of a potentially fatal illness. For all cancer patients, then, intervention for suffering should include concern for and management of the pain and distress associated with procedures.
Much of the data available on the management of procedure-related pain comes from studies on children with cancer and addresses nonpharmacologic management. For these guidelines, relevant data on cognitive-behavioral management in children were extrapolated to adults when there were no studies with adult patients.
Managing Procedure-Related Pain
Pharmacologic Strategies for Procedural Pain
Sedation for Procedural Pain
Pain in Neonates, Children, and Adolescents
Delirium and Its Effects on Treating Pain