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. 2022 Mar 14;14(6):1473.
doi: 10.3390/cancers14061473.

Pain Coping Strategies in Pediatric Patients with Acute Leukemias in the First Month of Therapy: Effects of Treatments and Implications on Procedural Analgesia

Marta Tremolada  1   2 , Giulia Tasso  2 , Roberta Maria Incardona  1 , Manuela Tumino  2 , Maria Caterina Putti  2 , Alessandra Biffi  2 , Marta Pillon  2
Affiliations

Pain Coping Strategies in Pediatric Patients with Acute Leukemias in the First Month of Therapy: Effects of Treatments and Implications on Procedural Analgesia

Marta Tremolada et al. Cancers (Basel). .

Abstract

Children with leukemia experience difficulties adapting to medical procedures and to the chemotherapy's adverse effects. Study's objectives were to identify which coping strategies could be associated with the treatments' factors and with the dosage of sedation analgesic drugs during bone marrow aspirates. A total of 125 patients (mean = 6.79 years; standard deviation = 3.40), majority with acute lymphoblastic leukemia (90.4%) and their parents received, one month after diagnosis, the Pediatric Pain Coping Inventory. Data on the severe treatment effects and on the dosage of drugs in sedation-analgesia were also collected. An ANCOVA model (R2 = 0.25) showed that, weighing the age factor (F = 3.47; df = 3; p = 0.02), the number of episodes of fever (F = 4.78; df = 1; p = 0.03), nausea (F = 4.71; df = 1; p = 0.03) and mucositis (F = 5.81; df = 1; p = 0.02) influenced the use of distraction. Cognitive self-instructions (R2 = 0.22) were influenced by the number of hospitalizations (F = 5.14; df = 1; p = 0.03) and mucositis (F = 8.48; df = 3; p = 0.004) and by child's age (F = 3.76; df = 3; p = 0.01). Children who sought parental support more frequently (F = 9.7; df = 2; p = 0.0001) and who tended not to succumb to a catastrophic attitude (F = 13.33; df = 2; p = 0.001) during the induction treatment phase required lower drug dosages, especially propofol. The clinical application of these results could be to encourage the use of cognitive self-instructions and search for social support.

Keywords: analgesia; children; coping; leukemia; pain; sedation; treatment effects.

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Conflict of interest statement

The authors declare no conflict of interest. The founding sponsors had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
(a): Use of distraction along children’s age ranges. (b): Use of cognitive self-instruction along children’s age ranges.
Figure 2
Figure 2
Comparison between the averages of the 5 coping strategies adopted along the average dosage of midazolam taken in the sedation induction phase for the diagnostic bone marrow aspirate.
Figure 3
Figure 3
Comparison between the averages of the 5 coping strategies adopted along the average dosage of propofol taken in the sedation induction phase for the diagnostic bone marrow aspirate.
Figure 4
Figure 4
Comparison between the averages of the 5 coping strategies adopted along the average dosage of propofol taken in the sedation induction phase for the bone marrow aspirate of day +15.
Figure 5
Figure 5
Comparison between the averages of the 5 coping strategies adopted along the average dosage of propofol taken in the sedation induction phase for the bone marrow aspirate of day +33.
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