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interventions such as lumbar punctures (LPs)
or expectations of the bone marrow (BMAs) as a
of the most difficult and painful aspects
of cancer.1, 2 figures show that the recurrence
The review was undertaken within the priorities of the NHS
Project. The NHS Priorities Project is funded
The Ministry of Health.
Address reprint requests to: Janet Richardson, PhD, RN,
Department of Health and Social Work, Portland Square,
University of Plymouth, Drake Circus, Plymouth,
Devon PL4 8AA, United Kingdom. E-mail: Janet.
richardson@plymouth.ac.uk.
Accepted for publication: June 23, 2005.
? 2006 U.S. Cancer Pain Relief Committee
Published by Elsevier Inc. All rights reserved.
0885-3924/06 / $ - see front matter
doi: 10.1016/j.jpainsymman.2005.06.010
70 Journal of pain and symptom management Vol. No. 31 January 1, 2006
these procedures does not desensitize the
child in distress. In addition, anxiety
is known that some patients
years after completion of cancer
treatment.3, 4
Pain is a complex and multifaceted experience.
An overall assessment of pain requires
variables such as cognitions, behaviors,
emotions, physiological reactions, and frame
must be evaluated and treated adequately.5 (P23)
Conventional treatment of painful and invasive
cancer-related processes in children
varies around the world. In the United Kingdom, for
example, the National Institute for Clinical Excellence
(NICE) Guidelines for Service plan to improve
Results in Children and Young People
Cancer emphasize the need for regular
painful procedures such as LP and bone marrow
biopsy; stress the importance of effective
Pain management for young cancer
patients, emphasizing the need for more children
general anesthesia (paragraphs 255 to 277) 0.6
The NICE guidelines recognize the role
imagination can play in a child's ability to cope
with painful procedures recommending that
children in hospital have daily access to play
or special activity coordinators to help
preparation for painful procedures. In addition,