Relationships between cognitive behavioral techniques, temperament, observed distress, and pain reports in children and adolescents during lumbar puncture

Abstract

A limited number of studies have examined relationships between temperament and children's/adolescents' responses to painful procedures and have identified several different dimensions of temperament that are related to children's pain response. The focus of these studies was one-time, acute pain experiences, such as immunization and postoperative pain. In this study, children and adolescents' responses to a moderately painful procedure, lumbar puncture, were examined as they related to temperament. Nineteen children and adolescents, ages 4 to 18 years, who were receiving treatment for cancer, were participants in this study. Parents completed one of three age-appropriate temperament questionnaires at the beginning of the study and prior to the parent and child learning cognitive-behavioral techniques. Behavior during the procedure was videotaped at baseline, and for up to four visits after baseline and coded using the Observation Scale of Behavioral Distress (OSBD). Pain reports were collected after the procedure using the Oucher pain self-report scale. Improvement in the level of behavioral distress was determined by examining the differences between pre- and post-treatment OSBD scores and self-reported pain ratings. There was a significant improvement in pain reports over the 5-month period, but behavioral distress did not change significantly. At the baseline visit, the temperament dimensions of more positive mood, lower activity, less persistence, and lower distractibility were related to higher pain reports, but not behavioral distress. However, after 5 months, only the dimension of positive mood was significantly correlated with improvement in pain reports. The amount of time parents and children practiced the techniques, their comfort with the techniques and their perceived effectiveness also were correlated with positive mood.