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Indian Journal of Medical and Paediatric Oncology
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ORIGINAL ARTICLE
Year : 2019  |  Volume : 40  |  Issue : 2  |  Page : 182-192

Procedural pain in lumbar punctures and the impact of preparation in pediatric cancer patients


1 Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
2 Faculty of Medicine, University of Lund, Lund, Sweden
3 Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India; Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada
4 Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India; Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada; Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
5 Lund University, Skane University Hospital, Department of Clinical Sciences and Oncology, Lund, Sweden
6 Lund University, Skane University Hospital, Department of Clinical Sciences and Pediatrics, Lund, Sweden
7 Skane University Hospital, Clinical Studies Sweden-Forum South, Lund, Sweden
8 Lund University, Faculty of Medicine, Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care; Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Region Skåne, Lund, Sweden

Correspondence Address:
Mikael Segerlantz
Senior Consultant, Palliative Care and Advanced Home Health Care, Sankt Lars Väg 90, 221 85 Lund
Sweden
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmpo.ijmpo_58_18

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Aim: Childhood cancer patients are subjected to recurring painful medical procedures. In low- and middle-income countries (LMIC), where the majority of the world's childhood cancer patients live, pain management is often unsatisfactory due to limited resources. This study aimed to evaluate the possibility of conducting a preprocedural preparation for lumbar punctures (LPs) at a pediatric oncology unit in a LMIC and to assess whether this intervention would decrease procedural pain and fear. Methods: Patients aged 5–18 who underwent LPs between February 25, 2017, and April 12, 2017, were eligible and invited to participate. Included patients were interviewed to assess the procedural pain and fear in conjunction with the LP and the patients' understanding of why an LP was done. Closest caregivers and the medical staff were interviewed to compare the perceptions of pain. The study was conducted in two separate phases; patients included in the period of February 25–March 9 underwent LP according to routines without preparation while patients included in the period of March 10–April 12 received procedural preparation with information. Results from the interviews from the two study groups were compared. Results: Out of 79 patients who met the inclusion criteria, 76 were included and preparation was successfully implemented for 25 of them. The pain decreased significantly (P = 0.022) after preparation. The physicians underestimated the patients' pain (P < 0.0001). The understanding of the reason for the LP increased significantly among patients (P = 0.0081) and their caregivers (P < 0.0001). Conclusions: Preparation by preprocedural information, created to fit the situation at a state-run hospital in a LMIC, is feasible and efficient.


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