Psychological Interventions for Needle-related Procedural Pain and Distress in Children and Adolescents

This week, as part of the Child Health Emergency Medicine Social Media Campaign, we are highlighting a Cochrane summary on psychological interventions for needle-related procedural pain and distress in children and adolescents. This review was selected for the TREKK Evidence Repository on procedural pain.

Key Messages:

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Related TREKK Resources:

Cochrane Summary:

Psychological interventions for needle-related procedural pain and distress in children and adolescents

Psychological interventions (for example, distraction, hypnosis, coping skills training) are treatments used to reduce pain and distress (anxiety and fear, or both) that children and adolescents experience while undergoing medical procedures involving needles. There is strong evidence that distraction and hypnosis are effective in reducing the pain and distress that children and adolescents experience during needle procedures. Distraction techniques can often be quite simple, such as reading the child stories, watching television, listening to music, or talking about something other than the needle. Sometimes parents or nurses are involved in helping to distract the child, although that is not always necessary. Interventions such as hypnosis may require some teaching by a trained professional for a child to learn. Other psychological treatments, such as explaining what is going to happen before or during the procedure (labelled ‘providing information or preparation or both’), using virtual reality (for example, interactive video equipment, goggles, computers showing images, games, stories), or a combination of various strategies have been tested. More research is needed to know whether they are effective for reducing children’s pain and distress during needles.

Authors’ Conclusions:

Overall, there is strong evidence supporting the efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents, with no evidence currently available for preparation and information or both, combined cognitive behavioural therapy (CBT), parent coaching plus distraction, suggestion, or virtual reality. Additional research is needed to further assess interventions that have only been investigated in one randomized controlled trial (RCT) to date (that is, memory alteration, parent positioning plus distraction, blowing out air, and distraction plus suggestion). There are continuing issues with the quality of trials examining psychological interventions for needle-related pain and distress.

Check Out the Full Cochrane Systematic Review Below:

Uman, L.S., Birnie, K.A., Noel, M., Parker, J.A., Chambers, C.T., McGrath, P.J., Kisely, S.R. (2013). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev, 10, CD005179. doi: 10.1002/14651858.CD005179.pub3

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This post is part of a weekly blog series highlighting pediatric emergency medicine (PEM) focused Cochrane summaries and other key resources selected by TREKK.

Published by arrangement with John Wiley & Sons.

Making medical procedures less painful for kids – the evidence

Source: Wikimedia Commons

Source: Wikimedia Commons

April 20, 2015 – This week’s blog post is also available from TREKK (TRanslating Emergency Knowledge for Kids).

Today we are going to discuss a topic that will be familiar to any parent, or to anyone who’s ever been a kid: the pain from medical procedures.  These can range from immunizations and blood tests through to less common things like lumbar punctures, inserting a catheter or starting an intravenous line.  All of these procedures have an important goal: supporting diagnosis and treatment.  But they can be really stressful for both children and their caregivers.

Doctors used to think that very young children did not experience pain, and, even if they did, did not remember it.  This has been repeatedly disproven over the past twenty years or so, and we now know that inadequate pain treatment can have a lot of negative effects in both the short and long term.

The experience of pain for a child is complex and is usually accompanied by anxiety, fear and behavioural changes. In the case of pain from medical procedures, health care professionals have a range of options for preventing or reducing the negative experience.

The Child Health Field’s journal, Evidence-Based Child Health, has published an overview of Cochrane evidence on reducing and preventing procedural pain for kids.  The kids in the studies included in this synthesis ranged in age from infancy (but not newborns) up to 19 years. The overview found three main conclusions:

1)  Behavioural therapies, such as showing videos to kids to distract them during a procedure, are effective and inexpensive, and should be used.

2)  Sweet-tasting substances have proven pain-reducing effect for procedures in early infancy, but have not been shown to have similar effect in older children.

3)  Amethocaine, a topical anaesthetic, works and should be used.

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Source: Wikimedia Commons

Dr. Samina Ali, one of the authors of the synthesis, commented that, “Despite our understanding of the importance of pain relief in children, there remains a significant knowledge-practice gap in clinical practice.”  It is our hope that publishing this overview of evidence will help overcome this gap so that receiving care is less painful for kids!

We hope you’ve found this post interesting – we’d love it if you left a comment to let us know what you think of it.  Any and all feedback is welcome!

Translating Emergency Knowledge for Kids (TREKK):

Other Resources:

  • A great video from the Centre for Pediatric Pain Research on reducing procedural pain – the producers of this video have no connection to our synthesis, but we think it’s a great video that deserves a wide audience, so please take a look!

References:

  1. Curtis, S., Wingert, A., & Ali, S. (2012). The Cochrane Library and procedural pain in children: an overview of reviews. Evidence‐Based Child Health: A Cochrane Review Journal, 7(5), 1363-1399.