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The management of pain during medical procedures in children with cancer focuses on providing as much comfort as possible for the child and parents during the procedure. Pain management is considered successful if the child is unafraid of undergoing subsequent procedures. The management of pain associated with pediatric procedures is discussed according to five age categories: birth to six months of age; six months to two years; two to five years; five to 12 years; and ages older than 12 years. The general principles of pain management are described. Procedures performed on children that are often associated with pain include bone marrow aspiration and biopsy, lumbar puncture, needle sticks into a vein or muscle, finger sticks, lances, and suturing (stitching). Various X-ray diagnostic techniques and treatment methods may not be associated with pain but may require patient cooperation in remaining still. Discomfort associated with various diagnostic procedures can be managed by drug therapy and/or behavioral techniques, and each patient should be assessed individually. The use of drug therapy is recommended for the first procedure to reduce the negative experience associated with illness and hospitalization. The medical staff should receive appropriate training and the environment should be modified to help relieve the discomfort associated with the procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fifty-four pediatric cancer patients were studied to determine the relative efficacy of two forms of behavioral intervention for reducing chemotherapy-related distress. Following baseline assessment, subjects were randomly assigned to receive either hypnosis, non-hypnotic distraction/relaxation, or attention placebo (control) during the subsequent identical chemotherapy course. Observational and interview measures of anticipatory and postchemotherapy nausea, vomiting, distress, and functional disruption served as outcome data. Results indicated that treatment condition was the single best predictor of change from baseline to intervention, with children in the hypnosis group reporting the greatest reduction of both anticipatory and postchemotherapy symptoms. The cognitive distraction/relaxation intervention appeared to have a maintenance effect in which symptoms did not get much worse or much better, while children in the control group had symptoms that consistently became worse over time. Emetic potential of the chemotherapy and the prophylactic use of antiemetics each appeared to contribute to the overall severity of symptoms. While the efficacy of hypnosis in the management of chemotherapy distress is supported, the complexities of interacting biologic and psychologic factors are highlighted.