The pain perception in the experience of childhood cancer

Author(s)

Hilze Benigno de Oliveira Moura Siqueira

• Document type: Doctoral Thesis
• Press: Ribeirão Preto.
• Institution: Universidade de São Paulo (USP). Escola de Enfermagem de Ribeirão Preto (PCARP/BC)
• Defense date: 2013-07-03

Examining board members

Fatima Aparecida Emm Faleiros Sousa; Ana Maria Pimenta Carvalho; Lucila Castanheira Nascimento; Ligia de Fátima Nóbrega Reato; Manoel Antonio dos Santos

• Advisor: Fatima Aparecida Emm Faleiros Sousa

Abstract

Despite the interest of the scientific research about the pain assessment in children/adolescents with cancer, such issue is still less investigated as compared to the research carried out with adult patients. The main aim of this study was to evaluate how children/adolescents with cancer and their family could understand the pain. For this purpose, the following instruments were used: sociodemographic and clinical indicators of pain and disease, Afective Faces Scale (FAS), Escala Multidimensional de Avaliação de Dor (EMADOR), drawings, and self-reports. The results showed that the age distribution (05-07, 08-11, and 12-19 years), with prevalence rates for age group between 12 and 19 years (45%), female (53%), elementary education (95%), and Catholics (62%). In addition, it was identified the highest rates for chronic pain (51%) and leukemia (47%). For the FAS results, the most indicated was the F-I figure (71%) representing a pain negative effect. For EMADOR instrument, the results for age group showed that the descriptors characterized in acute pain were related with affective and cognitive dimensions. On the other hand, in relation to chronic pain, such dimensions were perceived as a procedural way, according to the cognitive development, varying from concrete thinking (sensory descriptors) to abstract (affective descriptors). For technical drawing, the child/adolescent with cancer indicated perception of pain ranging between the magical thinking to the mental representations with metaphors more elaborated. The reports revealed that the pain was associated to experience and subjectivity of children/adolescents with cancer through the physical, social, emotional, and spiritual dimensions. In relation to the relatives, especially by mothers, it was noticed that the childhood cancer painful experience was perceived in similar way to the ill child, i.e. bidirectionally linked to the context and the time in which the disease entered them. The pain was perceived by summing the qualitative (subjective) and quantitative (objective). Thus, it was concluded that the pain was thought multidimensionally. EMADOR was considered an easy and reliable tool to assess the pain in the development process; i.e, children with cancer from 05 years old were able to understand painful phenomenon as well as their mothers, after themselves. This multidimensional complex interrelation of pain indicates the importance of using appropriate instruments in the public health, specifically, by means of the interdisciplinary team (\'care-pain\') for pain evaluation, in which it takes into account feelings, perceptions, and meanings possibly related with the pain experience (\'pain-experience\'). Therefore, this study brings opportunities for a better multidisciplinary management of the phenomenon in the field of pediatric pain. (AU)