Congress Abstracts 2006

11

PROCEDURAL PAIN IN ONCOLOGY PATIENTS: WHAT THE EVIDENCE REVEALS. Ginna Deitrick, BSN, Hospital of the University of Pennsylvania, Philadelphia, PA; and Rosemary Polomano, PhD, RN, FAAN, University of Pennsylvania School of Nursing, Philadelphia, PA.

Advances in aggressive cancer therapies expose patients to repeated invasive diagnostic procedures to monitor treatment responses. Oncology patients frequently report pain associated with procedures such as bone marrow aspiration (BMA) and lumbar puncture (LP). By one person's account it is "the most difficult aspect of having cancer", often worse than the disease itself (Klein, 1992). Sensitivity to painful experiences and knowledge and timing of pain relieving interventions play a critical role in minimizing procedural pain and emotional distress.

An evidence-based review of the literature was conducted to examine the state of knowledge and gaps in research related to experiences with procedural pain from invasive procedures and therapeutic strategies to control pain and alleviate associated symptoms. Physiological mechanisms of tissue injury, psychological experiences, and evaluations of pharmacological and non-pharmacological approaches on patient outcomes

An exhaustive search in citation databases, MedLine, PubMed and CINAHL, identified publications on the current state of research and practice on pain and anxiety with painful invasive procedures. A detailed evidence table summarizes populations studied, research designs, outcomes and relevant findings that can be applied to clinical practice.

A critical appraisal of research on procedural pain shows more emphasis on pediatric oncology populations. Limited data are available on effective treatment approaches with adults. Pharmacological interventions using moderate and deep sedation with the use of opioids and sedating agents are acceptable, safe treatment options; however, concurrent use of complementary therapies such as distraction and hypnosis also holds considerable promise.

Apprehension and anxiety contribute to pain and distress for patients undergoing BMA and LPs in both pediatric and adult oncology populations. Results from investigations of pharmacological approaches and alternative and complementary therapies can be translated into practice-based protocols to effectively manage procedural pain and address patient safety concerns with sedation and analgesia. However, more research is needed to adequately describe these experiences and to document the benefits of both pharmacological and non-pharmacological interventions.