Psychological and Physical Interventions for  the Management of Cancer-Related Pain in Pediatric and Young Adult Patients: An Integrative Review.
OBJECTIVE
To identify and appraise current evidence related to the effectiveness of psychological and physical (nonpharmacologic) pain management modalities for children and young adults with cancer .


METHODS
Electronic searches in MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science (from database inception to June 2013) for clinical trials.


RESULTS
A total of 32 unique studies were identified. Substantial heterogeneity existed across identified studies, precluding meta-analysis. Therefore, a narrative review of included studies is presented. Studies featured psychological and/or physical pain interventions for children and young adults (N = 1,171) aged 1-21 years with a variety of cancer diagnoses. Interventions included aromatherapy, art therapy, distraction, hypnosis, physical activity, physical positioning, touch therapy, and multimodal cognitive-behavior therapy. Twenty-two studies (69%) reported success in preventing or reducing pain intensity. The level of evidence and methodologic quality of studies were generally low .


CONCLUSIONS
Current nonpharmacologic pain interventions for pediatric and young adult patients with cancer are diverse. Several modalities significantly decreased pain intensity, suggesting that these strategies may be effective methods of pain treatment, particularly in the case of painful medical procedures. Future well-designed, multicenter, randomized, controlled trials are needed to further discern treatment effects on pain and other health outcomes in this population and to compare the relative effectiveness of different modalities.


CONCLUSIONS
Nurses play a key role in pain assessment and management in pediatric and young adult patients with cancer. The studies included in this review constitute the beginnings of an evidence base that supports the need to implement psychological and physical interventions to improve pain outcomes in pediatric and young adult patients with cancer.
University of Toronto.
Lindsay A
LA
Jibb
University of Toronto.
Paul C
PC
Nathan
University of Toronto.
Bonnie J
BJ
Stevens
University of Toronto.
Emily
E
Seto
University of Toronto.
Joseph A
JA
Cafazzo
Mount Sinai Hospital.
Nisha
N
Stephens
The Hospital for Sick Children in Toronto.
Liza
L
Yohannes
University of Toronto.
Jennifer N
JN
Stinson
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D001523:Mental Disorders; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D011613:Psychotherapy; D055815:Young Adult
cancer; nonpharmacologic; pain management; pediatric; physical; psychological