Cognitive behavioral intervention to anxiety and pain during a medical procedure: Case report for a girl with acute lymphoblastic leukemia

Abstract

Acute lymphoblastic leukemia (ALL) is the most common oncological disease in children under 15 years of age; whose medical treatment is based on high doses of chemotherapy for two or three years. It is estimated that during this period a child receives up to 300 injections, which makes the treatment one of the main causes of pain. The intrathecal chemotherapy is a medical procedure evaluated as painful. The management of pain includes pharmacological treatment and psychological interventions like cognitive-behavioral psychological techniques which have shown moderate evidence of their use. However, there is not enough evidence in the pediatric oncology population. This paper shows a single case report of an eight year old female patient with a diagnosis of ALL undergoing intrathecal chemotherapy without anesthetics due to a medical condition. The patient received psychological intervention based on psychoeducation and deep breathing to manage pain, anxiety, and stress behaviors before a medical procedure. During chemotherapy, behavioral complications occurred that did not interfere with the usual course of the procedure, while anxiety and pain ratings remained at low and moderate scores, respectively. In conclusion, psychoeducation and deep breathing can be effective techniques for the non-pharmacological management of acute pain in pediatric patients undergoing medical procedures, in addition to being viable in hospital contexts since they require a short training time.