Susan M. Jay

Behavioral management of children's distress during painful medical procedures

Abstract The purpose of the current study was to develop and assess the efficacy of a psychological intervention program to reduce the behavioral distress of pediatric cancer patients undergoing highly-painful medical procedures (bone-marrow aspirations and lumbar punctures) which are required for the diagnosis and treatment of their disease. The psychological intervention was delivered to 5 patients ages 3 1 2 –7yr within the context of a staggered baseline design. Results suggested that the program was effective at reducing behavioral distress for all 5 patients during the initial intervention. However, 1 S showed some regression of intervention effects during a second treatment session. Possible alternative explanations for the results obtained were discussed and implications for future research were presented.

A Stress Inoculation Program for Parents Whose Children Are Undergoing Painful Medical Procedures.

The efficacy of a stress inoculation intervention program was compared with that of a child focused intervention program in helping parents cope with their childrens painful medical procedures. Ss included 72 parents (79% mothers) of pediatric leukemia patients (aged 3-12 years) who were undergoing either bone marrow aspirations (n = 28) or lumbar punctures (n = 44). Parents were assessed during a baseline procedure and then were randomly assigned to either a stress inoculation group or a child-focused intervention group. In the child focused intervention, parents merely observed their childs participation in a cognitive behavior therapy program. Assessment of parents included an observation measure of parent behavior, self-reported measures of anxiety and coping, and physiological measures. Results indicate that parents in the stress inoculation program reported lower anxiety scores and higher positive self-statement scores than did parents in the child-focused intervention.

An investigation of cognitive-behavior therapy combined with oral valium for children undergoing painful medical procedures.

In previous research, a cognitive-behavioral therapy (CBT) package was found to be effective in reducing childrens distress associated with the painful medical procedures of bone marrow aspirations (BMAs) and lumbar punctures (LPs). Orally administered Valium demonstrated less effectiveness but was helpful in reducing behavioral distress before the medical procedure. In the present study, we investigated whether the combination of oral Valium and CBT would result in increased efficacy of the CBT. Eighty-three subjects were randomly assigned to receive either CBT or CBT plus Valium while undergoing either a BMA or an LP. Dependent variables included observed behavioral distress, self-reported fear and pain, and pulse rate. Results failed to support the value of such a combination but did provide additional evidence in regard to the effectiveness of the CBT. The need for more potent medical interventions for some children is discussed.

Acute and chronic pain in adults and children with cancer.

This article reviews current research and clinical practice concerning pain experienced by cancer patients. Etiological subtypes of pain (disease related vs. treatment related) are discussed, and an overview of assessment methodology for acute and chronic pain is presented. Also discussed are psychological interventions for pain in cancer patients and the efficiency of current research findings. A review of the literature indicates a need for basic research, for controlled outcome studies of psychological interventions, and for education of health care professionals in the mechanisms and management of pain.

The Management of Pain Associated with Pediatric Procedures

This article provides guidelines for the psychological and pharmacologic management of pain and anxiety for children undergoing medical procedures. The goals of intervention are presented, as well as issues warranting consideration in planning intervention to reduce procedure-related distress.

Chronic pain in children

Abstract Chronic pain in children was reviewed in two major categories: disease-related pain and recurrent pain syndromes. Problems with the traditional dichotomy of organic versus psychogenic origins of such pain were noted. Additionally, disturbing trends in the pharmacological management of childrens chronic pain were discussed. Furthermore, applications of psychological interventions to both pain categories were outlined and have shown exciting potential for the amelioration of a number of childrens chronic pain problems. However, research in this area is only beginning to demonstrate efficacy and controlled outcome studies are few in number. Finally, a brief review of strategies for the assessment of childrens chronic pain was presented and revealed an area also in its infancy.

Psychological aspects of cancer in children, adolescents, and their families

Abstract With improving medical management and survival of children and adolescents with cancer, increasing attention is being focused on the quality of life for the patient and family. This review will discuss the psychological aspects of various phases in the illness process and highlight major issues in intervention. It is concluded that the psychological care of children and adolescents with cancer can serve as a model for comprehensive care in other pediatric disorders as well.

Biobehavioral factors in juvenile rheumatoid arthritis: Implications for research and practice

Abstract Juvenile rheumatoid arthritis is the most common connective tissue disease in children. Juvenile rheumatoid arthritis may best be conceptualized as a syndrome of diverse etiologies with three distinct types of disease onset: systemic, poly articular, and pauciarticular. The overall management of juvenile rheumatoid arthritis consists of a multidisciplinary approach to comprehensive care. Biobehavioral factors are delineated into four primary areas: therapeutic adherence, arthritic pain, psychosocial adjustment, and functional independence. To date, relatively little systematic biobehavioral research has been conducted in juvenile rheumatoid arthritis; however, the potential for the interdisciplinary biobehavioral approach to this pediatrie chronic disorder is quite evident.

Psychological Intervention for Pain in Pediatric Cancer Patients

Pain is a frequently encountered experience for the child with cancer. The diagnosis of malignancy is accompanied by a panoply of bloodtests, injections, vena punctures, and periodic bone marrow aspirations and lumbar punctures (spinal taps) which are administered at frequent intervals over a period of years. In addition, the disease process, particularly in the final stages, can cause severe pain for the pediatric cancer patient. The coping capacities of pediatric cancer patients are challenged and sometimes overtaxed by this arduous series of aversive events which must be mastered during the adjustment process if the child is to emerge from this life-threatening situation with emotional and physical well-being. Psychology, as a discipline, has much to offer pediatric oncology in the area of assessment and management of pain.

Pain in Children: An Overview of Psychological Assessment and Intervention

The problem of pain in children has received little attention in the medical and psychological literature. In contrast to the wealth of information concerning theory research, and clinical application in the area of pain management with adult patients, the literature on assessment and management of children’s pain is characterized almost exclusively by anecdotal reports and by the absence of systematic, controlled research. The paucity of relevant literature on pediatric pain was illustrated by Eland and Anderson (1977) who conducted a thorough search of the medical literature on pain from 1970 and 1975. The search revealed 1350 articles on pain, yet only 33 of these dealt with pediatric pain. Furthermore, the 33 articles were almost all related to differential diagnosis or specific diagnostic examinations to be done and contained little or no data on assessment or treatment of children’s pain behaviors. Since 1975, psychologists have begun to address the problem of pain in children through research as well as clinical application. The purpose of this chapter is to provide a concise overview of the psychological literature on assessment and intervention in pediatrics.