Dor iatrogênica em oncologia e sua prevenção / Iatrogenic cancer pain and its prevention

JUSTIFICATIVA E OBJETIVOS: A dor oncológica é assunto de extrema importância em Portugal, uma vez que a doença oncológica é causa de morbilidade e morte e a sua incidência tem vindo a aumentar nas últimas décadas como consequência do progressivo aumento da esperança de vida. Devido ao desconhecimento da prevalência da dor iatrogênica, nos hospitais, associado à sua desvalorização, o objetivo deste estudo foi contribuir para uma nova consciência e agir dos profissionais de saúde e dar ênfase à formação, sobre formas de a prevenir, sendo esta uma ferramenta fundamental para melhorar a comunicação com o paciente e minimizar a rotina hospitalar.CONTEÚDO: Foram realizados numerosos progressos com o objetivo de avaliar e aliviar a dor dos pacientes oncológicose vários estudos refletem sobre os efeitos iatrogênicos dos tratamentos de quimioterapia e radioterapia.No entanto, nem todas as dores são atribuíveis à doença.Algumas relacionam-se com os cuidados e procedimentos invasivos, realizados pelos profissionais.CONCLUSÃO: É essencial refletir sobre a importância do cuidar como parte fundamental do paciente e não apenas tratar e curar a doença, pois a mecanização da saúde pode minimizar a comunicação e agravar o sofrimento.

BACKGROUND AND OBJECTIVES: Cancer pain isa very important subject in Portugal since cancer leads to morbidity and mortality and its incidence is increasing inthe last decades as a consequence of the progressive life expectation increase. Due to the unawareness of iatrogenic pain prevalence in hospitals, associated to its depreciation,this study aimed at contributing for a new awareness and action of health professionals and at emphasizing their qualifi cation, about ways to prevent iatrogenic pain,being this a fundamental tool to improve communication with patients and to minimize hospital routine.CONTENTS: There has been progress in cancer patients' pain evaluation and relief and several studies address the iatrogenic effects of chemotherapy and radiotherapy. However, not all pains are attributable to the disease. Someare related to care and invasive procedures performed byhealth professionals.CONCLUSION: It is essential to think about the importance of care as fundamental part of patients and not onlytreat and cure the disease, because health mechanization may minimize communication and worsen suffering.

Can indian classical instrumental music reduce pain felt during venepuncture.

Objective. To determine comparative efficacy of local anesthetic cream, Indian classical instrumental music and placebo, in reducing pain due to venepuncture in children. Methods. Children aged 5-12yr requiring venepuncture were enrolled in a prospective randomized clinical trial conducted at a tertiary care center. They were randomly assigned to 3 groups: local anesthetic (LA), music or placebo (control) group. Eutactic mixture of local anesthetic agents (EMLA) and Indian classical instrumental music (raaga-Todi) were used in the first 2 groups, respectively. Pain was assessed independently by parent, patient, investigator and an independent observer at the time of insertion of the cannula (0 min) and at 1- and 5 min after the insertion using a Visual Analog Scale (VAS). Kruskal- Wallis and Mann-Whitney U tests were used to assess the difference amongst the VAS scores. Results. Fifty subjects were enrolled in each group. Significantly higher VAS scores were noted in control (placebo) group by all the categories of observers (parent, patient, investigator, independent observer) at all time points. The VAS scores obtained in LA group were lowest at all time points. However, the difference between VAS scores in LA group were significantly lower than those in music group only at some time-points and with some categories of observers (parent: 1min; investigator: 0-, 1-, 5 min and independent observer: 5 min). Conclusion. Pain experienced during venepuncture can be significantly reduced by using EMLA or Indian classical instrumental music. The difference between VAS scores with LA and music is not always significant. Hence, the choice between EMLA and music could be dictated by logistical factors.