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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2019; 40(02): 182-192
DOI: 10.4103/ijmpo.ijmpo_58_18
Original Article

Procedural Pain in Lumbar Punctures and the Impact of Preparation in Pediatric Cancer Patients

Sudha Sinha
Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
,
Magdalena Marczak
Faculty of Medicine, University of Lund, Lund, Sweden
,
Jean Jacob
Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
Two Worlds Cancer Collaboration- INCTR, Vancouver, British Columbia, Canada
,
Gayatri Palat
Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
Two Worlds Cancer Collaboration- INCTR, Vancouver, British Columbia, Canada
Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
,
Eva Brun
Lund University, Skane University Hospital, Department of Clinical Sciences and Oncology, Region Skåne, Lund, Sweden
,
Thomas Wiebe
Lund University, Skane University Hospital, Department of Clinical Sciences and Pediatrics, Region Skåne, Lund, Sweden
,
Tommy Schyman
Skane University Hospital, Clinical Studies Sweden-Forum South, Region Skåne, Lund, Sweden
,
Mikael Segerlantz
Lund University, Faculty of Medicine, Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care, Region Skåne, Lund, Sweden
Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Region Skåne, Lund, Sweden
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Aim: Childhood cancer patients are subjected to recurring painful medical procedures. In low- and middle-income countries (LMIC), where the majority of the world’s childhood cancer patients live, pain management is often unsatisfactory due to limited resources. This study aimed to evaluate the possibility of conducting a preprocedural preparation for lumbar punctures (LPs) at a pediatric oncology unit in a LMIC and to assess whether this intervention would decrease procedural pain and fear. Methods: Patients aged 5–18 who underwent LPs between February 25, 2017, and April 12, 2017, were eligible and invited to participate. Included patients were interviewed to assess the procedural pain and fear in conjunction with the LP and the patients’ understanding of why an LP was done. Closest caregivers and the medical staff were interviewed to compare the perceptions of pain. The study was conducted in two separate phases; patients included in the period of February 25–March 9 underwent LP according to routines without preparation while patients included in the period of March 10–April 12 received procedural preparation with information. Results from the interviews from the two study groups were compared. Results: Out of 79 patients who met the inclusion criteria, 76 were included and preparation was successfully implemented for 25 of them. The pain decreased significantly (P = 0.022) after preparation. The physicians underestimated the patients’ pain (P < 0.0001). The understanding of the reason for the LP increased significantly among patients (P = 0.0081) and their caregivers (P < 0.0001). Conclusions: Preparation by preprocedural information, created to fit the situation at a state-run hospital in a LMIC, is feasible and efficient.

Keywords

Low/middle-income countries - pediatric oncology - preprocedural preparation - procedural pain


Publication History

Article published online:
03 June 2021

© 2019. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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