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

Abstract

For the current issue of the Journal, we asked Drs Anna Taddio and C Meghan McMurtry to comment on and put into context the Cochrane Review on psychological interventions for needle-related procedural pain and distress in children and adolescents (1). Background This review is an updated version of the original Cochrane review published in Issue 4, 2006. Needle-related procedures are a common source of pain and distress for children. Our previous review on this topic indicated that several psychological interventions were efficacious in managing paediatric needle pain including distraction, hypnosis and combined cognitive behavioural interventions. Considerable additional research in the area has been published since that time. Methods Search strategy Searches of the following databases were conducted for relevant randomized controlled trials (RCTs): Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; PsycINFO; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Web of Science. Requests for relevant studies were also posted on various electronic list servers. An updated search was conducted in March 2012 and again in March 2013. Selection criteria Participants included children and adolescents two to 19 years of age undergoing needle-related procedures. Only RCTs with ≥5 participants in each study arm comparing a psychological intervention group with a control or comparison group were eligible for inclusion. Data analysis Two review authors extracted data and assessed trial quality, and a third author helped with data extraction and coding for one non-English study. Included studies were coded for quality using the Cochrane Risk of bias tool. Standardized mean differences with 95% CIs were calculated for all analyses using Review Manager version 5.2. Results Thirty-nine trials with a total of 3394 participants were included. The most commonly studied needle-related procedures were veni-puncture, intravenous line insertion and immunization. Studies included children two to 19 years of age, with the most evidence available for children <12 years of age. Consistent with the original review, the most commonly studied psychological interventions for needle procedures were distraction, hypnosis and cognitive behavioural therapy (CBT). The majority of included studies (19 of 39) examined distraction only. The additional studies from this review update continued to provide strong evidence for the efficacy of distraction and hypnosis. No evidence was available to support the efficacy of preparation and information, combined CBT (≥2 cognitive or behavioural strategies combined), parent coaching plus distraction, suggestion or virtual reality for reducing children’s pain and distress. No conclusions could be drawn about interventions of memory alteration, parent positioning plus distraction, blowing out air or distraction plus suggestion because evidence was available from single studies only. In addition, the risk of bias scores indicated several domains with high or unclear bias scores (eg, selection, detection and performance bias), suggesting that the methodological rigour and reporting of RCTs of psychological interventions continue to exhibit considerable room for improvement. 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 CBT, parent coaching plus distraction, suggestion or virtual reality. Additional research is needed to further assess interventions that have only been investigated in one RCT to date (ie, 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. The full text of the Cochrane Review is available in The Cochrane Library (1).