Children's Perceptions of Pain During 3 Weeks of Bone Marrow Transplant Experience

Most patients undergoing bone marrow transplant (BMT) experience severe pain. Because self-reporting is the most reliable source when assessing pain, it is important that health care providers understand how children perceive their pain and alleviating factors. The purpose of this descriptive, exploratory study was to understand children's perceptions of: (a) their BMT pain, (b) interventions effective in relieving their pain, and (c) caregivers' role in managing their pain. The sample consisted of 20 children (50% male), age 5 to 17 years, undergoing BMT. All study participants received continuous-infusion opioid therapy with additional boluses as needed for pain. Using investigator-developed structured interview guides, children were interviewed four times: on the day of transplant, then at three weekly intervals. Data were analyzed using a content analysis approach. In the first interview, children reported that when they hurt, they most commonly told someone. Several children used nonpharmacologic techniques to relieve pain. Although all had been told to expect some pain during BMT, only one-third of the children described the kinds of pain that they anticipated having during BMT. During subsequent interviews, the majority said that medication worked best to decrease their pain. In the final interview, most children said they still hurt. They reported pain predominantly in their mouth and throat, but mentioned seven other pain sites. Anecdotal comments included that pain management should be improved on the first BMT day and that nurses need to teach children that it is okay to use drugs for pain. Implications for clinical practice, education, and research are discussed.