These outstanding documentary films were authored by Leora Kuttner, PhD, a pediatric clinical psychologist, who specializes in children's pain management. In the 1980s, Dr. Kuttner pioneered a project that involved teaching children, families, and medical staff how to use techniques such as breathing, mental imagery, and medical play to reduce anxiety and pain during medical procedures. The first film of this 2-volume set, “No Fears, No Tears,” documents the experiences of 8 children with cancer, aged 3 to 12 years, as they use these techniques to cope with scary and painful medical procedures. The second film, “No Fears, No Tears-13 Years Later,” revisits the now grown children, explores their memories of pain, and how using coping techniques impacted their lives. The purpose of these films is to demonstrate that with adequate preparation, practice, and parental and medical staff support, even young children can learn techniques to reduce anxiety and pain and that mastery of these techniques can have lasting positive effects on an individual's sense of well-being.
In the first film, through a series of interviews, viewers are intimately introduced to the children and their parents, as they describe the specific techniques they use to lessen fear and pain. Viewers will appreciate Dr. Kuttner's sensitive interviewing style and the use of actual footage of the children using the techniques during medical procedures. The ability of each child to harness his or her own natural abilities to control experiences of fear and pain is depicted clearly and is truly remarkable and inspirational.
In the second film, Dr. Kuttner talks with the now young adults about their memories of pain during treatment and how their experiences of learning to take control of their pain affected their lives. Many express that learning specific techniques to reduce pain during cancer treatment was “empowering” and that they have since used these techniques to cope with pain experienced later in life. In a particularly touching interview, one individual recalls how she used the techniques that she learned to help her mother manage her own cancer-related pain.
This film also highlights the now grown children's positive attitudes and abilities to flourish as individuals and participate fully in life. The use of footage from the original film, in conjunction with follow-up interviews and footage depicting the children's later accomplishments, is an extremely powerful method of portraying the resiliency of these courageous individuals.
One limitation of these otherwise outstanding films is that they do not seem to include children from minority backgrounds or children with developmental disabilities. For these films to reach to a wider audience, it would be useful to include a more diverse group of children.
Overall, “No Fears, No Tears” and “No Fears, No Tears-13 Years Later” are moving and inspirational and provide an intimate look at the experiences of pain among children with cancer and the impacts of using nonpharmacological techniques to lessen anxiety and pain during medical procedures. These films highlight the ability of even very young children to learn to take control of pain, as well as the importance of collaboration between child, parent, and medical staff to effectively minimize a child's pain. They provide hope and are an excellent resource for children with cancer, their families, and clinicians. They also serve as a valuable teaching tool for medical students and pediatric residents, reinforcing the message that lessening children's experiences of fear and pain during medical procedures is extremely important in promoting children's well-being in the long run.
The author declares no conflict of interest.
Elizabeth Poole-Di Salvo, MD, Children's Evaluation and Rehabilitation Center, Albert Einstein College of Medicine and The Children's Hospital, Montefiore, New York, NY
Â'© 2012 Lippincott Williams & Wilkins, Inc.