Acute pain in chronically ill children: Psychological assessment and intervention.

Five separate studies are reported on two groups of chronically ill children: children with end-stage renal failure who had received renal transplants and children with insulin dependent diabetes mellitus (IDDM). Assessment studies of both these groups investigated psychosocial factors influencing children's anxiety, pain and distress during venipunctures. Behavioural, cognitive and physiological measures of pain were used as well as standardized and structured interview questionnaires. The assessment studies involved 21 renal transplant children and 62 chidren with IDDM. The results found a revised version of the Observation Scale of Behavioural Distress to be a valid and reliable measure of children's distress during venipuncture. The predictor variables for children's distress in the transplant sample were the child's self-concept for social acceptance and the child's usual anxiety over injections. In the diabetic sample, the presence of emotional/conduct disorder, the child's usual anxiety over bloodtests and parent's rating of the child's usual anxiety over bloodtests were the three predictor variables for children's distress. Other significant psychosocial variables are discussed. Bloodtests were reported to be the most stressful aspect of the medical treatment by parents of children with renal transplants and by diabetic children. A pilot study is reported of cognitive-behavioural and hypnotic intervention with children in the transplant clinic. Cogntive-behavioural intervention was found to be effective in reducing distress during venipuncture in children aged four to seven years, following renal transplantation. With older children aged 6-16 years, both cognitive-behavioural and hypnotic intervention were effective in reducing diabetic children's distress. However, control groups appeared to improve following baseline observations, possibly as a result of non-specific factors such as attention and therapist presence. The results are discussed in relation to the literature on acute pain in children.