Psychological Interventions for Needle-Related Procedural Pain in Children
Objective: To report the results of a systematic review of randomized controlled trials (RCTs) of psychological interventions for children and adolescents undergoing needle-related procedures.
Methods: A variety of cognitive-behavioral psychological interventions for managing procedural pain and distress in children and adolescents between 2 and 19 years of age were examined. Outcome measures included pain and distress as assessed by self-report, observer report, behavioral/observational measures, and physiological correlates.
Results: Twenty-eight trials met the criteria for inclusion in the review and provided the data necessary for pooling the results. Together, the trials included 1,039 participants in treatment conditions and 951 in control conditions. The largest effect sizes for treatment improvement over control conditions were found for distraction, combined cognitive-behavioral interventions, and hypnosis, with promising but limited evidence for several other psychological interventions.
Conclusions: Recommendations for conducting future RCTs are provided, and particular attention to the quality of trial design and reporting is highlighted.
Children often experience unpredictable and severe procedure-related pain in hospitals that can be associated with negative emotional and psychological implications (Cummings, Reid, Finley, McGrath, & Ritchie, 1996; Kazak & Kunin-Batson, 2001). These medical procedures also cause anxiety, fear, and behavioral distress for children and their families, further intensifying their pain and interfering with the procedure (Broome, Bates, Lillis, & McGahee, 1990). Medical procedures, particularly needles, are among the most feared experiences reported by children (Broome et al., 1990).
Psychological interventions for managing pain and distress in children are primarily cognitive-behavioral treatments (CBT). CBT interventions for pain management assist the child to develop and apply coping skills to manage the pain and distress, and when developmentally appropriate, to help the child comprehend how thoughts and behaviors can alter their experience of pain (Keefe, Dunsmore, & Burnett, 1992).
Several narrative, nonsystematic reviews of psychological interventions for the management of procedural pain and distress in children are available (Blount, Piira, & Cohen, 2003; Chen, Joseph, & Zeltzer, 2000; Christophersen & Mortweet, 2001; Powers, 1999). While these reviews typically conclude that psychological interventions are beneficial, the lack of a systematic and pooled approach to integrating the literature limits conclusions regarding the efficacy of these interventions. There have been a few more systematic approaches to integrating this literature (Kleiber & Harper, 1999; Saile, Burgmeier, & Schmidt, 1988), but these reviews are limited in that they have a narrow focus (e.g., distraction only) and are out of date given the rapid growth in research in this area. Furthermore, recent recommendations for enhancing reviews of psychological treatments in pediatric populations suggest that reviews should include meta-analyses, clinical significance, and theory-guided interventions (Drotar, 2002). The present review follows these recommendations, and summarizes our systematic review and meta-analysis for the Cochrane Collaboration (www.cochrane.org) on the efficacy of cognitive-behavioral interventions for managing needle-related procedural pain and distress in children and adolescents (Uman, Chambers, McGrath, & Kisely, 2006). The Cochrane Collaboration (www.cochrane.org) is an international not-for-profit organization, with the mandate of providing up-to-date information, and translation of systematic reviews related to health care. This article is based on a Cochrane Review published in the Cochrane Library, 2006, Issue 4 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of this review. Cochrane Reviews are published in the Cochrane Library (an online resource); however, given the rigorous criteria they follow, they are often quite extensive and lengthy. To promote knowledge translation, they are often published in abbreviated formats in relevant academic journals. Thus, this review presents an abbreviated version of the original Cochrane Review, highlighting the main procedures, conclusions, and recommendations. This review extends and expands from previous reviews in this area by: (a) providing a more up-to-date synopsis of the literature, (b) including a meta-analytic component, and (c) evaluating a wide range of psychological interventions.
This article is an abbreviated version of a larger review first published with the Cochrane Collaboration: Uman, L.S., Chambers, C.T., McGrath, P.J., Kisely, S. (2006). Psychological interventions for needle-related procedural pain and distress in children and adolescents (Review). The Cochrane Database of Systematic Reviews, 4.
Abstract and Introduction
Abstract
Objective: To report the results of a systematic review of randomized controlled trials (RCTs) of psychological interventions for children and adolescents undergoing needle-related procedures.
Methods: A variety of cognitive-behavioral psychological interventions for managing procedural pain and distress in children and adolescents between 2 and 19 years of age were examined. Outcome measures included pain and distress as assessed by self-report, observer report, behavioral/observational measures, and physiological correlates.
Results: Twenty-eight trials met the criteria for inclusion in the review and provided the data necessary for pooling the results. Together, the trials included 1,039 participants in treatment conditions and 951 in control conditions. The largest effect sizes for treatment improvement over control conditions were found for distraction, combined cognitive-behavioral interventions, and hypnosis, with promising but limited evidence for several other psychological interventions.
Conclusions: Recommendations for conducting future RCTs are provided, and particular attention to the quality of trial design and reporting is highlighted.
Introduction
Children often experience unpredictable and severe procedure-related pain in hospitals that can be associated with negative emotional and psychological implications (Cummings, Reid, Finley, McGrath, & Ritchie, 1996; Kazak & Kunin-Batson, 2001). These medical procedures also cause anxiety, fear, and behavioral distress for children and their families, further intensifying their pain and interfering with the procedure (Broome, Bates, Lillis, & McGahee, 1990). Medical procedures, particularly needles, are among the most feared experiences reported by children (Broome et al., 1990).
Psychological interventions for managing pain and distress in children are primarily cognitive-behavioral treatments (CBT). CBT interventions for pain management assist the child to develop and apply coping skills to manage the pain and distress, and when developmentally appropriate, to help the child comprehend how thoughts and behaviors can alter their experience of pain (Keefe, Dunsmore, & Burnett, 1992).
Several narrative, nonsystematic reviews of psychological interventions for the management of procedural pain and distress in children are available (Blount, Piira, & Cohen, 2003; Chen, Joseph, & Zeltzer, 2000; Christophersen & Mortweet, 2001; Powers, 1999). While these reviews typically conclude that psychological interventions are beneficial, the lack of a systematic and pooled approach to integrating the literature limits conclusions regarding the efficacy of these interventions. There have been a few more systematic approaches to integrating this literature (Kleiber & Harper, 1999; Saile, Burgmeier, & Schmidt, 1988), but these reviews are limited in that they have a narrow focus (e.g., distraction only) and are out of date given the rapid growth in research in this area. Furthermore, recent recommendations for enhancing reviews of psychological treatments in pediatric populations suggest that reviews should include meta-analyses, clinical significance, and theory-guided interventions (Drotar, 2002). The present review follows these recommendations, and summarizes our systematic review and meta-analysis for the Cochrane Collaboration (www.cochrane.org) on the efficacy of cognitive-behavioral interventions for managing needle-related procedural pain and distress in children and adolescents (Uman, Chambers, McGrath, & Kisely, 2006). The Cochrane Collaboration (www.cochrane.org) is an international not-for-profit organization, with the mandate of providing up-to-date information, and translation of systematic reviews related to health care. This article is based on a Cochrane Review published in the Cochrane Library, 2006, Issue 4 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of this review. Cochrane Reviews are published in the Cochrane Library (an online resource); however, given the rigorous criteria they follow, they are often quite extensive and lengthy. To promote knowledge translation, they are often published in abbreviated formats in relevant academic journals. Thus, this review presents an abbreviated version of the original Cochrane Review, highlighting the main procedures, conclusions, and recommendations. This review extends and expands from previous reviews in this area by: (a) providing a more up-to-date synopsis of the literature, (b) including a meta-analytic component, and (c) evaluating a wide range of psychological interventions.
This article is an abbreviated version of a larger review first published with the Cochrane Collaboration: Uman, L.S., Chambers, C.T., McGrath, P.J., Kisely, S. (2006). Psychological interventions for needle-related procedural pain and distress in children and adolescents (Review). The Cochrane Database of Systematic Reviews, 4.
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