Title: Cognitive and behavioral strategies to reduce children's pain
Authors: Kachoyeanos MK and Friedhoff M.
Journal: Am J Matern Child Nurs. 1993 Jan/Feb
Purpose: To review the use of reported strategies to help children deal with pain and distress of hospitalization and invasive treatment procedures. Imagery, distraction, relaxation, play, various tactile techniques and other cognitive and behavioral strategies are known to be effective in managing a child’s pain and distress from cancer related therapies.
Types of Cognitive Strategies:
· Hypnosis (Guided Imagery) is effective with child three years and older who have an active imagination (example: pain switch; the child is asked to switch off the pain in the area they are experiencing pain)
· Story telling is another strategy, where the child develops the story and listens to a story
· Imagery combined with tactile sensation would be the use of magic glove or magic blanket. The child is told that the magic glove will lessen the discomfort from a needle stick
· Tactile transference is used when the site of pain is not accessible, such as a spinal tap. The nurse strokes the child’s back where the tap is to be done and the child’s hand at the same time. The child is told that at the time of the tap he/she will have their hand stroked and should feel the same soothing sensation where the tap is being placed.
· Emotive Imagery is active distraction that would involve the child (counting the tiles on the ceiling, a pacifier, blowing bubbles, holding tightly to the parents’ hands. In passive distraction the child watches something distracting.
· Music is a good distraction technique. Usually soft, low-pitched instrumental music has been shown to be effective, even comatose children respond to music.
· Relaxation techniques involving slow deep breathing or blowing out are also effective.
Types of Behavior Strategies
· With the use of modeling the child learns about the procedure and ways to cope. This could be done live or using videotape.
· Desensitization exposes the child to the anxiety-provoking experience through play. Such as child playing with syringe before being an injection.
How Cognitive and Behavioral Strategies work:
· They propose that mechanism in the dorsal horn of the spinal cord act as a gate, and allow or prevent the flow of pain impulses from peripheral fibers to the CNS depending on the extent to which the gate is open.
· Output of transmission cells must reach a certain threshold before the message of pain can be transmitted to the brain
· Attention, memory and emotion influence the gating mechanism. If you reduce the emotional and physical impulses you in turn reduce the output of the transmission cells, thus inhibiting pain impulses from reach the brain.
· There is a need to create the environment for pain reduction, such as training staff in pain reduction procedures through CE workshops
Basic Principles of Cognitive Pain Control:
· Willingness on the part of the child to learn these techniques
· Parent involvement and cooperation will further ensure success
· Regular practice and contact with a profession or parent who knows the techniques will help the child from relapsing and forgetting to use the technique
· Costs nothing to implement
· Save staff time
· The strategies work
· Children need not suffer needlessly
· Techniques do require a commitment on the part of the caregivers.