Emotion Regulation and Pain in Children With Cancer
Condition: Cancer
Study type: Interventional

Summary: 
      This study tested the effects of emotion regulation strategies (reappraisal, reassurance, and
      empathy) on pain responses in children with cancer. Children with cancer were randomly
      assigned to one emotion regulation strategy during an experimental pain task (the cold
      pressor task [CPT]). During the CPT, children rated their pain and provided saliva samples
      immediately before, after, and then 15 minutes after the CPT. This study examined the
      influence of emotion regulation on self-reported pain and physiological activity assessed
      through saliva samples.
    

Detailed description: 
      More than 12,000 children are diagnosed with cancer in the United States each year and the
      majority of these children will experience pain throughout their illness. Children with
      cancer are required to undergo repeated invasive medical procedures, including bone marrow
      aspirations (BMA) and lumbar punctures (LP), which have been described by children as the
      most distressing and painful aspect of their illness. The experience and memory of procedural
      pain can have a lasting effect and impact distress in future procedures; children learn to
      anticipate pain and show increased distress and decreased cooperation at subsequent
      procedures. Moreover, childhood medical distress has also been linked to adults' reports of
      pain and fear around medical events and even avoidance of future health care. Early painful
      procedures have also been associated with behavioral changes to medical events later in life,
      a finding that is supported by recent physiological evidence indicating that activation of
      the pain processing system in the brain can change neuropathways, which leads to increased
      sensitivity to later stimulation of pain systems. Therefore, it is vital to develop
      strategies to minimize the pain and distress that children undergo through cancer treatment
      and understanding the impact of children's memory on pain is a crucial step in this process.

      To address this important need, this study involved identifying the strategies that children
      use to cope with distress that promote positive memories of medical events, examining how
      these strategies impact their immediate physiology (via salivary biomarkers) and
      self-reported pain, and understanding how these coping strategies change children's distress
      over time during future medical procedures. Specifically, certain coping strategies change
      the way that children interpret stressful medical procedures, which affects the emotional
      response to future procedures. These objectives were accomplished by the following specific
      aims:

      Aim 1: Identify emotion-regulation (i.e., coping) strategies that promote more positive
      memories of distressing medical procedures in children with cancer.

      Aim 2: Assess the impact of emotion-regulation strategies on children's distress response to
      painful procedures over time.

      This project will provide specific means for impacting children's pain and distress during
      medical procedures. Specifically, because the emotion regulation strategies described in this
      protocol are modifiable and teachable, they provide direct implications for clinical practice
      in pain management by identifying strategies that can decrease children's pain and anxiety
      throughout their course of cancer treatment.
    

Intervention name(s): Reapprasial Condition; Reassurance Condition; Distraction Condition
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Children in this condition will be instructed to think about how the procedure will help them become adjusted to cold weather.; Children will be reassured by the experimenter .; Children in this condition will be instructed to focus their attention on a picture on a computer screen rather than on the pain.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Supportive Care
Keywords: cancer; salivary alpha amylase; pain; positive affect; emotion regulation strategies