Hypnosis as an Adjunct for Managing Pain in Head and Neck Cancer Patients Post Radiotherapy.

Background: Many factors contribute to pain in cancer patients. Hypnotherapy is the mental processes, involving conscious and unconscious awareness to understanding of the pain to correct thought, improve emotional acceptance, and reduce pain by the patient themselves. Objective: To examine the effects of hypnotherapy on pain reduction in the patient's with head and neck cancer after radiation therapy. Material and Method: A randomized controlled clinical trial was conducted with the 68 patients who were divided into two groups, i.e., 34 patients undergoing hypnotherapy and 34 patients received usual care. Visual analogue scales (VAS) were used for pain assessment. Results: Sixty-eight patients were recruited in the present study and half were randomly assigned to hypnotherapy group. One participant in the treatment and two participants in the control groups discontinued before the end of the study. Demographic data were comparable in the two groups. No complication was found during, immediately after, or five days after the procedure. After adjusted with baseline, gender, age, non-opioid, week-opioid, and strong-opioid, hypnosis treatment demonstrated significantly less pain score -1.966, (95% CI -2.260 to -1.673, p-value <0.001) than the control group. Conclusion: Hypnosis can reduce pain in patients with head and neck cancer after radiation therapy and it is much better when using combination with the strong opioids. The hypnosis command can be used to reduce chronic pain for cancer patients with head and neck in addition to the usual treatments. Relationships between clinician and patient, patient's knowledge, exploring patient's difficulties, and hypnosis training are all important factors to be considered before the hypnotherapy.

My child you must have patience and Kreng Jai: Thai parents and child pain.

PURPOSE: To elicit the experiences of parents in providing care for their hospitalized child's acute pain needs. DESIGN: Phenomenology, using in-depth interviews with 45 parents whose children were being cared for in five hospitals in Northeastern (Isan) Thailand. FINDINGS: The findings address Thai cultural beliefs regarding the experience of pain and the role societal expectations have on parental behavior in trying to meet their child's acute pain needs. Two themes emerged-"Understanding my child's pain: it's karma" and "Maintaining Kreng Jai"-which identify parent beliefs toward pain and pain treatment, as well as perceived barriers in securing pain management for their children. Together these two themes describe the essence of this study as parents experienced an "inner struggle in providing pain care." Pain was perceived as an inescapable part of life, and participants identified a preference for traditional remedies. Parents experienced a tension as they wanted to provide and secure pain care for their child but at the same time were reticent to approach staff with concerns about their child's care. CONCLUSIONS: Thai parents viewed pain as a normal consequence of life, and one had to use traditional remedies in addition to medicine to successfully treat pain. Societal behavioral expectations required children to have patience. Nevertheless, parents wanted professionals to show more empathy and provide more effective pain care. CLINICAL RELEVANCE: Improvements in pediatric pain care must formally include parents. Culturally sensitive approaches that do not stereotype parents and children are needed to ensure that evidence-informed pain care is available for all children.

Children's pain assessment in northeastern Thailand: perspectives of health professionals.

Deficiencies in pain care within the developing world are starting to be realized. Children, in particular, are vulnerable, as preliminary studies suggest that these children receive less pain treatment because of health professionals' attitudes and beliefs. This article reports on some of the findings of the first study in a larger program of research aimed at improving pediatric pain care in Thailand. Improvements in practice are not simply the result of providing evidenced-based knowledge, but a complex process that includes the context of care. Given that little is known about the pain management experiences of Thai health professionals, including the challenges they face, we used focus groups to capture their stories. Data revealed a need for both updating pain knowledge and for supporting an increased use of appropriate practices. In this article, we focus on the issues concerning the assessment of pain resulting from underrecognizing children's pain and complex issues in communicating findings of children's pain.

The development and validation of the Khon Kaen University Pediatric Pain Assessment Tool for school-aged Isaan children in Thailand.

This research was aimed at developing a tool for pain assessment specifically for parents to use with children of the Isaan culture of Northeast Thailand. The Khon Kaen University (KKU) Pediatric Pain Assessment Tool was first constructed through the use of a qualitative study and literature reviews. Then, it was modified using the results of a pilot study with 38 stakeholders. Seventeen nurses, 150 postoperative children, and 150 family caregivers participated in a study comparing the tool with the standard Faces Scale and Numeric Rating Scale. Results revealed no difference in children's pain scores, as well as no statistical difference in children's pain score ratings between the three groups, suggesting the new tool is appropriate for Isaan children.

Cultural influences on parental responses to children's pain.

There is a scarcity of work examining the relationship between culture and pain-related caregiver behaviors. Moreover, no pediatric pain studies have examined the relationship between caregiver cultural values and pain-related caregiver behaviors nor discern if this process is mediated by caregiver parenting styles and moderated by ecosocial context. Based on cross-cultural developmental theories, this study hypothesized that ecosocial context would moderate the relationship between cultural values, parenting styles, and pain-related caregiver behaviors; and that parenting styles mediate the effect of cultural values on pain-related caregiver behaviors. A cross-cultural survey design was employed using a convenience sample of 547 caregivers of 6 to 12 year olds living in Canada (n = 183), Iceland (n = 184), and Thailand (n = 180). Multigroup structural equation modeling showed that ecosocial context did not affect which cultural model of parenting the caregiver adopted. Parenting styles mediated the relationship between cultural values and pain-related caregiver behavior. Vertical/horizontal individualism, collectivism, and authoritative- and authoritarian-parenting styles positively predicted solicitousness. Vertical individualism and authoritarian-parenting style positively predicted discouraging behavior, whereas other predictors did not. The findings support the sociocommunication model of children's pain by showing that cultural context does affect parents' behaviors. They also corroborate with others' claims of solicitousness universality in a pediatric pain context. However, solicitousness may have different cultural meanings among individuals and may be used in conjunction with discouraging behavior. The findings from this study have implications for the theory development about culture and pediatric pain, but do not provide specific clinical recommendations.

The effect of fluid density and volume on the accuracy of test weighing in a simulated oral feeding situation.

BACKGROUND: For preterm infants and infants who have difficulty with oral feeding, excessive drooling during oral feedings can result in inaccurate assessment of intake. The drooled volume is typically estimated by visual and tactile assessment of the bib. Research, however, has demonstrated that visual assessment is inaccurate. PURPOSE: The purpose of this study was to determine the accuracy of a scale that was used for the test weighing of milk that was drooled during a study of oral feeding for preterm infants. Additionally, the effect of weighing solutions with different densities on the accuracy of test weights was examined. METHOD: Descriptive, comparative design. PROCEDURES: A simulated feeding situation was performed using 3 fluids (water, Enfamil(20), and Enfamil(24)) and 3 volume ranges (1 mL to 10 mL, 11 mL to 20 mL, and 21 mL to 30 mL). Data collection sessions were conducted for each of the 3 fluids using each range of volumes, for a total of 180 test weights. The research assistant performing the test weights was blinded to the preweight of the bib and the amount of fluid being applied to the bib. RESULTS: Differences between the actual volume applied to the bib and the volume estimated by the scale were very small, with 51% of the differences equaling 0 mL and 48% of the differences between -1 mL and 1 mL. There were significant differences in errors related to both the type of fluid (F = 25.7; df = 2; P < 0.001) and volume range (F = 12.7; df = 2; P < 0.001), as well as for the interaction between the 2 factors (F = 7.02; df = 4; P < 0.001). Water had significantly less mean error than either formula, and large volumes had significantly greater mean error than either small or medium volumes. CONCLUSIONS: Test weighing is an accurate method for measuring fluids of different densities and volumes in a simulation of drooling during oral feeding. The increased error with larger volumes of higher density solutions was not clinically significant. The study supports the need to consider both the accuracy of the scale and characteristics of the fluid when test weighing is used to measure volumes of fluids.