DIFFERENCES AMONG RATERS EVALUATING THE SUCCESS OF EMLA CREAM IN ALLEVIATING PROCEDURE-RELATED PAIN IN CHILDREN WITH CANCER

We evaluated the analgesic efficacy of EMLA cream after repeated bone marrow aspirations or lumbar punctures (LPs) in children with cancer, and compared the ratings among patients, their parents, physicians, an d nurses. Data from LPs were analyzed at the last procedure without EM LA (T1) and the first and last procedures with EMLA (T2 and T3). Fried man's nonparametric analysis of variance was used for statistical anal ysis. A total of 272 procedures in 29 children were analyzed. For 179 procedures without EMLA, physicians rated pain lower than other raters , and for the 93 with EMLA physicians rated pain less than the childre n. Children rated pain at T2 lower than at T1 or T3. Physicians rated pain at T2 less than at T3. Both children and physicians rated pain at T3 as not different from that at T1. No differences were noted at the se time points for other raters in LP distress ratings, or in bone mar row aspiration pain or distress ratings. Thus EMLA was associated with decreased pain ratings for LPs, but this effect was not sustainable w ith repeated procedures. The cream alone should not be relied on to co ntrol pain of bone marrow aspiration or repeated LPs in children. Phys icians underestimated pain, which may have implications for undertreat ment in this patient population.