Samuel LeBaron

Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer

Hypnosis was compared with nonhypnotic behavioral techniques for efficacy in reducing pain and anxiety in 27 children and adolescents during bone marrow aspiration and in 22 children and adolescents during lumbar puncture. The patients and independent observers each rated (scale of 1 to 5) pain and anxiety during one to three procedures prior to intervention and one to three procedures with intervention. Prior to intervention for both groups, pain during bone marrow aspiration was rated as more severe (P less than 0.01) than pain during lumbar puncture. During bone marrow aspiration pain was reduced to a large extent by hypnosis (P less than 0.001) and to a smaller but significant extent by nonhypnotic techniques (P less than 0.01), and anxiety was significantly reduced by hypnosis alone (P less than 0.001). During lumbar puncture only hypnosis significantly reduced pain (P less than 0.001); anxiety was reduced to a large degree by hypnosis (P less than 0.001) and to a smaller degree by nonhypnotic techniques (P less than 0.05). Thus hypnosis was shown to be more effective than nonhypnotic techniques for reducing procedural distress in children and adolescents with cancer.

Relief of anxiety and pain in children and adolescents with cancer: Quantitative measures and clinical observations

Abstract Children and adolescents with cancer, chiefly forms of leukemia, aged 6 to 19 years, underwent medical treatments which required repeated bone marrow aspirations, normally a painful and anxiety-provoking experience. Data were obtained in baseline bone marrow observations on 63 patients, who were then offered the opportunity to volunteer for hypnotic help in pain control. Of the 24 patients who accepted hypnosis, 19 were highly hypnotizable. 10 of the 19 reduced self-reported pain substantially by the first hypnotic treatment (the prompt pain reducers) and 5 more reduced self-reported pain by the second treatment (the delayed pain reducers) while none of the 5 less hypnotizable patients accomplished this. The latter benefitted by reducing anxiety. Short case reports illustrate the variety of experiences. Analysis of baseline observations before any therapeutic intervention revealed age and sex differences. The difference between self-reported and observed pain was not statistically significant for...

Assessment of quality of survival in children with medulloblastoma and cerebellar astrocytoma

To determine the quality of survival for children with posterior fossa tumors, comprehensive neuropsychological, behavioral, and academic assessment and physician ratings of functional status were obtained on 15 brain tumor patients (ages 6–19 years) at a median of 20 months postdiagnosis. More than 50% of the children (whether irradiated or not) experienced major problems in academic, motor, sensory, cognitive, and emotional function. All but two children were reported by teachers to be “slow workers,” and four of 15 patients were able to maintain their school work in regular classes. Although 80% of the patients were rated by physicians as having “excellent” or “good” functional status, no relationship was found between these global ratings and psychometric measures. Although the affected site was the posterior fossa, deficits also involved higher cortical function. These findings indicate the need for further evaluation of treatment effects and the provision of intervention for survivors.

The effectiveness of behavioral intervention for reduction of nausea and vomiting in children and adolescents receiving chemotherapy.

Fifty-one children 6-17 years of age rated the severity of nausea, vomiting, and the extent to which chemotherapy bothered them during each course of chemotherapy. Sixteen patients had no symptoms and the doses administered to 16 others were not constant so that matched courses could not be assessed. After baseline measurement of two matched courses, the remaining 19 patients were randomized to receive hypnosis or supportive counseling during two more matched courses. An additional course with no intervention was assessed in half of the patients. No significant reduction of symptoms was demonstrated prior to intervention. However, intervention with both hypnosis and supportive counseling was associated with significant reductions in nausea, vomiting, and the extent to which these symptoms bothered patients (all p less than 0.001). Also, after termination of intervention, symptom ratings remained significantly lower than baseline. The data indicate that chemotherapy-related nausea and emesis in children can be reduced with behavioral intervention and that reductions are maintained after intervention has been discontinued.

The cold pressor pain paradigm in children: feasibility of an intervention model (Part II).

&NA; The purpose of this study was to examine the feasibility of testing a psychological approach (hypnosis) to pain reduction in children using the cold pressor paradigm. Childrens pain ratings at 10 sec intervals and duration of arm immersion (40 sec maximum) in 15 °C (n = 37) and 12 °C water (n = 29) were assessed in 6–12‐year‐old children during 2 baseline trials (alternating arms), followed by 2 more trials after randomization to a control or hypnosis treatment condition. Hypnosis was found to reduce pain significantly more than the control condition in both 15 °C and 12 °C water. Hypnotic susceptibility was not strongly related to hypnotic pain reduction. However, age was significant, with younger children showing higher pain ratings and early arm withdrawal rates and less response to hypnosis than older children. In 15 °C water, females had higher pain ratings and early withdrawal rates than males, but this sex discrepancy disappeared in 12 °C water. This study demonstrated the feasibility of the cold pressor paradigm for testing intervention strategies and its potential for enhancing our understanding of pain in children.

An investigation of cold pressor pain in children (part I)

&NA; Although the cold pressor model of pain has been used widely in laboratory studies with adults, it has been rarely used to study pain in children, likely because of obvious ethical concerns about the well‐being of child participants. The goals of the present investigation were to determinel (1) whether a laboratory study of this type could be conducted in a way that children would find interesting and non‐threatening, and (2) whether potentially useful data could be gathered systematically within the framework of such a study. Results of a pilot study in children 6–12 years, with water temperature at 15°C (n = 37) and 12°C (n = 29), indicated that useful data could be obtained from this paradigm. Childrens pain ratings increased with duration of arm immersion in the water and with decreasing water temperature. Most importantly, children and their parents perceived the format to be interesting and non‐stressful. Continued caution and improved techniques for monitoring the well‐being of child participants need to be a part of any future investigations of this type.

Behavioral intervention for reducing chemotherapy-related nausea and vomiting in adolescents with cancer

Eight adolescents (10-17 years, mean 12.1) with cancer received behavioral intervention for chemotherapy-related nausea and vomiting. Within 3-5 days after the administration of each course of chemotherapy, patients rated (1-10 scale; 1 = none, 10 = maximum) their nausea and vomiting and the extent to which chemotherapy bothered them and disrupted their daily routine. After a baseline (preintervention) assessment of 2-3 courses of chemotherapy, patients received intervention during another 2-3 courses. While no significant reduction of symptoms were found prior to intervention, with intervention there were reductions in nausea (Z = 2.37, p less than 0.02), vomiting (Z = 2.52, p less than 0.01), bother (Z = 2.24, p less than 0.02), and disruption of activities (Z = 2.38, p less than 0.02). This preliminary study suggests that chemotherapy side effects in adolescents can be reduced with behavioral intervention.

Paradoxical effects of prophylactic phenothiazine antiemetics in children receiving chemotherapy.

The effectiveness of prophylactic phenothiazine antiemetics on reduction of nausea and vomiting was assessed for 23 children (age, 9-17 years) who had intermittently received antiemetics (ie, for one course but not for another). Each patient was his own control and the courses with antiemetics were compared to the matched courses without antiemetics (Wilcoxon matched-pairs, signed-ranks test). In each case, the matched courses with and without antiemetics were temporally consecutive and equivalent for chemotherapeutic agents and dosages. Significantly higher ratings for severity of nausea (P less than .004), vomiting (P less than .02), and the extent to which these symptoms bothered patients (P less than .001) were found during courses with prophylactic antiemetics. Duration (in hours) of nausea and vomiting was analyzed for the last eight consecutive study patients; in eight of eight patients, a significantly longer duration of nausea (P less than .05) and vomiting (P less than .02) was found for the courses in which antiemetics were given prophylactically. This study suggests that prophylactic phenothiazine antiemetics do not predictably reduce childrens nausea and vomiting and may even be associated with an increase in symptoms. Further studies in children are needed to determine which patients might benefit most from antiemetic intervention.

Imaginative involvement and hypnotizability in childhood

Abstract 2 pilot studies were conducted to assess the relationship between hypnotizability in children and the extent of involvement in fantasy-related activities during early childhood. The Stanford Hypnotic Clinical Scale for Children (Morgan & Hilgard, 1978/79) and a structured interview questionnaire regarding fantasy activities based on previous work by Singer (1973) were given to 30 medical patients aged 6–18 years in the first study and to 37 healthy children aged 6–12 years from a school population in the second study. In both studies, hypnotizability correlated moderately (.42 and .39, respectively) with extent of involvement in fantasy-related activities. Results of these studies support Hilgards (1979) findings that hypnotizability is related in part to the development of imaginative involvement in childhood.

Does ethnicity constitute a risk factor in the psychological distress of adolescents with cancer

To determine if ethnicity constitutes a risk factor in the psychological distress of adolescents with cancer, ethnic comparisons (Hispanic versus Anglo) were made on four psychological measures administered to 54 adolescents with cancer. Data from the largely Mexican-American San Antonio sample were then compared to test scores from a largely Anglo Los Angeles sample. A San Antonio subsample of 25 adolescents with cancer who received behavioral intervention for relief of treatment-related distress were retested on these psychological measures at six months following intervention and test score changes were compared to those found in a similar Los Angeles study. No ethnic differences were found on any measure. The Los Angeles findings of normal trait anxiety and self-esteem in adolescents with cancer and the findings that adolescents with cancer perceive little control over their health and the significant impact of their illness were similar to those in San Antonio. Reasons for the even higher impact of illness found in the San Antonio sample are discussed. Adolescents from both sites demonstrated similar reductions in their trait anxiety scores following behavioral intervention. We conclude that ethnicity per se does not appear to have a major influence on the experience of cancer in adolescents. Nevertheless, our findings suggest that membership in a minority group and a clinics attitudes toward ethnic differences may play important roles in acceptance or rejection of behavioral intervention and thus merit investigation.