Abstract
BackgroundVenipuncture pain in children results from a variety of co-factors which increase the intensity of the nociceptive stimulus. Among them, anticipatory anxiety plays an important role. Children with chronic diseases undergo invasive procedures and venipuncture more often than other children. Some healthcare professionals still believe that children who are repeatedly exposed to painful procedures, such as children with chronic diseases, gradually increase their pain tolerance and that, as a result, they have a higher pain threshold than children with no chronic diseases. The purpose of this study was to assess whether a difference exists in the perception of venipuncture pain between children with chronic diseases and children with no previous health problems nor experience of venipuncture.MethodsA cross-sectional study was carried out using the Wong and numeric pain scales and the Observational Scale of Behavioral Distress (OSBD) for the assessment of behavioral distress. A group of children with chronic diseases and a group of children with no previous health problems nor experience of venipuncture, aged 4 to 12 years, both boys and girls, were observed during a standardized venipuncture procedure.ResultsThe study included 230 children in total: 82 of them suffered from chronic diseases and had already experienced venipuncture at least once, while the remaining 148 children had no previous experience of venipuncture. The children with chronic diseases reported more pain (median pain score of 8 on the Wong or numeric scales,) and showed more signs of behavioral distress (median score of 27 on the OSBD) than non-chronic children (median pain score of 2 on the Wong/numeric scales, p = 0.00001; median OSBD score 5, p = 0.00001).ConclusionsOur study suggests that children with chronic diseases have a lower pain threshold than children of the same sex and age who experience venipuncture for the first time.
Highlights
Venipuncture pain in children results from a variety of co-factors which increase the intensity of the nociceptive stimulus
It is well established that children remember painful experiences [1,2] and that the way they commit such experiences to memory conditions how they react to subsequent exposures to painful procedures [3,4]
The purpose of this research was to compare the pain perceived and the behavioral distress shown during a standardized venipuncture by children with chronic diseases who have already been exposed to venipuncture, with those of a group of children who have never had any health problem before and who have no previous experience of venipuncture, in order to evaluate if differences exist
Summary
Venipuncture pain in children results from a variety of co-factors which increase the intensity of the nociceptive stimulus. In addition to situational and methodological influences -for example, the passage of time or the format of questioning- children’s reports of painful events can relate to individual differences, such as age, gender, temperament, anxiety, prior experiences and pain threshold [3]. Rocha et alii examined the effects of temperament and trait anxiety on memory of pain: trait-anxious children tended to recall more pain than they initially reported, indicating that their recollections of pain could have been distorted. Temperament, it is believed to influence sensitivity and reactivity to stressful events, [12,13,14,15] did not show any significant effect on pain recollection [4]. Parental variables and strategies for coping pain carried out when performing a medical procedure can shape children’s memory of a stressful event, as the insertion of an intravenous needle [16]
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