Painful Medical Procedures Research Articles

Comparison of the Effectiveness of Buzzy, Distracting Cards and Balloon Inflating on Mitigating Pain and Anxiety During Venipuncture in a Pediatric Emergency Department

<i>Background</i> Painful medical procedures in childhood may have long-term negative effects on development and future tolerance of pain, evidence suggests that a significant number of children receive less than optimal management of procedure-related pain <i>Objective </i>The present study aim to investigate the efficacy of three interventions methods (Buzzy, distracting cards and balloon inflating) on mitigating pain and anxiety associated with venipuncture in a group of pediatric patients. <i>Methods</i> A prospective randomized clinical trial with children who required venipuncture and aged 7 to12 years was conducted in a pediatric ED. Data were obtained by conducting interviews with the children, their parents, and the observer. The pain levels of the children were assessed by the parent, observer as well as self-report using the Faces Pain Scale-Revised (FPS-R). The anxiety levels of children were assessed using Children Fear Scale (CFS). <i>Results </i>One hundred and eighty children (mean age, 9.3±1.9 years) were included. The pain levels of children showed statistically significant differences between the groups in the self-, observer- and parent-reported procedural pain (p = 0.012, p = 0.036, p = 0.014 respectively).No significant differences were observed between the groups in procedural child anxiety levels according to the parents and observer (p =0. 42, 0.13 respectively). <i>Conclusion</i> The results of the study suggests that the distraction method through Buzzy, distraction cards and balloon inflating are effectively decreased pain levels of children compared with the control group according to self-report, parent-report and observer-report.

Cognitive Behavioural Therapy (CBT) and Treatment of Paediatric Patients with Chronic Renal Disease

The aim of this study was to evaluate the effectiveness of an intervention with CBT in patients with chronic renal disease. The study findings are in the context of previous researches and existing theories. Searches were done in the professional literature related to different chronic diseases and respectively with Chronic Kidney Disease in children and adolescents. Many paediatric chronic diseases are difficult to be managed because of the limitations caused by the disease itself; consequently, some of them need to be subjected to painful and difficult medical procedures as well. Respectively, for children diagnosed with CKD life changes completely because of limitations, mainly physical ones, due to the characteristics of the disease which require constant adaption as well as development of strategies to face the disease. Their behaviours must change accordingly as part of a new life of self-care. Cognitive-Behavioural Therapy is a psychological therapy, which has been investigated extensively and has been found as very effective to reduce psychological symptoms caused by the disease. This therapy integrates the modification of behaviour with the cognitive restructuring, the aim of which is to change the patient’s unhealthy behaviours through cognitive and behaviour techniques. Keywords: children; chronic kidney disease; cognitive behavioural therapy

Analysing and exploring practice: a working model of music therapy as procedural support for invasive medical procedures

Background: Children and adults experiencing hospitalization may undergo a myriad of anxiety-provoking and painful medical procedures, which may carry traumatic impact. Music therapy as procedural support may be defined as the use of music and aspects of the therapeutic relationship to promote healthy coping and decrease distress in individuals undergoing medical procedures.Methods: This session describes a working model of music therapy as procedural support derived from a process of qualitative content analysis of music therapy clinical and research publications on the topic. This transactional model consists of a complex, non-linear interaction among patient, therapist, music, procedure and context. Key elements of the model include the impact of multifaceted moderating variables, the crucial aspect of reflexivity present within ongoing assessment and alteration of clinical approaches, and the need to individually tailor the approach for the person and context. Case examples will be used to illustrate ...

Effectiveness of medical hypnosis for pain reduction and faster wound healing in pediatric acute burn injury: study protocol for a randomized controlled trial.

BackgroundBurns and the associated wound care procedures can be extremely painful and anxiety-provoking for children. Burn injured children and adolescents are therefore at greater risk of experiencing a range of psychological reactions, in particular posttraumatic stress disorder, which can persist for months to years after the injury. Non-pharmacological intervention is critical for comprehensive pain and anxiety management and is used alongside pharmacological analgesia and anxiolysis. However, effective non-pharmacological pain and anxiety management during pediatric burn procedures is an area still needing improvement. Medical hypnosis has received support as a technique for effectively decreasing pain and anxiety levels in adults undergoing burn wound care and in children during a variety of painful medical procedures (e.g., bone marrow aspirations, lumbar punctures, voiding cystourethrograms, and post-surgical pain). Pain reduction during burn wound care procedures is linked with improved wound healing rates. To date, no randomized controlled trials have investigated the use of medical hypnosis in pediatric burn populations. Therefore this study aims to determine if medical hypnosis decreases pain, anxiety, and biological stress markers during wound care procedures; improves wound healing times; and decreases rates of traumatic stress reactions in pediatric burn patients.Methods/DesignThis is a single-center, superiority, parallel-group, prospective randomized controlled trial. Children (4 to 16 years, inclusive) with acute burn injuries presenting for their first dressing application or change are randomly assigned to either the (1) intervention group (medical hypnosis) or (2) control group (standard care). A minimum of 33 participants are recruited for each treatment group. Repeated measures of pain, anxiety, stress, and wound healing are taken at every dressing change until ≥95 % wound re-epithelialization. Further data collection assesses impact on posttraumatic stress symptomatology, speed of wound healing, and parent perception of how easy the dressing change is for their child.DiscussionStudy results will elucidate whether the disease process can be changed by using medical hypnosis with children to decrease pain, anxiety, and stress in the context of acute burn wounds.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12615000419561

Predicting preschool pain-related anticipatory distress: the relative contribution of longitudinal and concurrent factors.

Anticipatory distress prior to a painful medical procedure can lead to negative sequelae including heightened pain experiences, avoidance of future medical procedures, and potential noncompliance with preventative health care, such as vaccinations. Few studies have examined the longitudinal and concurrent predictors of pain-related anticipatory distress. This article consists of 2 companion studies to examine both the longitudinal factors from infancy as well as concurrent factors from preschool that predict pain-related anticipatory distress at the preschool age. Study 1 examined how well preschool pain-related anticipatory distress was predicted by infant pain response at 2, 4, 6, and 12 months of age. In study 2, using a developmental psychopathology framework, longitudinal analyses examined the predisposing, precipitating, perpetuating, and present factors that led to the development of anticipatory distress during routine preschool vaccinations. A sample of 202 caregiver-child dyads was observed during their infant and preschool vaccinations (the Opportunities to Understand Childhood Hurt cohort) and was used for both studies. In study 1, pain response during infancy was not found to significantly predict pain-related anticipatory distress at preschool. In study 2, a strong explanatory model was created whereby 40% of the variance in preschool anticipatory distress was explained. Parental behaviours from infancy and preschool were the strongest predictors of child anticipatory distress at preschool. Child age positively predicted child anticipatory distress. This strongly suggests that the involvement of parents in pain management interventions during immunization is one of the most critical factors in predicting anticipatory distress to the preschool vaccination.

Emotional regulation of mothers bringing up children with burn injury

IntroductionBurn injuries occupy 11th place in the list of causes of infant mortality and 5th in the list of the most common non-fatal childhood injuries (WHO, 2014). The situation of getting a burn injury, prolonged hospitalization, painful medical procedures, the threat of a child's life results in mother's unusual and heavy emotional experience. Adequate processing of this experience will be an important factor in her future mental health. The study involved 35 mothers hospitalized with their children because of burn trauma.ObjectivesThe aim of the study was to describe the characteristics of emotional regulation and emotional response of mothers bringing up children with burn injury.Goals(1) Describe the phenomenа of emotional regulation, found in mothers whose children have experienced a burn injury; (2) determine factors that cause appearance of special emotional phenomena among these mothers.MethodsСlinical interview, Beck Depression Inventory, State Trait Anxiety Inventor, Cognitive Emotion Regulation Questionnaire (CERQ).ResultsA significant numbers of mothers shows a high level of anxiety and depression, which may be predictive of the development of PTSD. The main cognitive strategies of emotion regulation – self-blame and disasterization are maladaptive. An important role played by unconscious strategy of emotion regulation, basically – situation selection and attentional deployment, as well as the social regulation of emotions: the availability of a good support from family members with adaptive strategies of emotional regulation, adequate reactions of other mothers in hospital associated with less emotional distress above mothers. There is no correlation between the severity of burn injury and the emotional response of the mother.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Beyond the drugs: nonpharmacologic strategies to optimize procedural care in children.

Painful and/or stressful medical procedures mean a substantial burden for sick children. There is good evidence that procedural comfort can be optimized by a comprehensive comfort-directed policy containing the triad of nonpharmacological strategies (NPS) in all cases, timely or preventive procedural analgesia if pain is an issue, and procedural sedation. Based both on well-established theoretical frameworks as well as an increasing body of scientific evidence NPS need to be regarded an inextricable part of procedural comfort care. Procedural comfort care must always start with a child-friendly, nonthreatening environment in which well-being, confidence, and self-efficacy are optimized and maintained. This requires a reconsideration of the medical spaces where we provide care, reduction of sensory stimulation, normalized professional behavior, optimal logistics, and coordination and comfort-directed and age-appropriate verbal and nonverbal expression by professionals. Next, age-appropriate distraction techniques and/or hypnosis should be readily available. NPS are useful for all types of medical and dental procedures and should always precede and accompany procedural sedation. NPS should be embedded into a family-centered, care-directed policy as it has been shown that family-centered care can lead to safer, more personalized, and effective care, improved healthcare experiences and patient outcomes, and more responsive organizations.

DREAM Project: Decreasing REcurrent pain and Anxiety in Medical procedures on a pediatric population

The DREAM project is a joint venture between the medical world, university professors and developers with one goal in mind: create an efficient distraction tool to reduce pain and anxiety in children receiving medical treatments. Growing evidence in the medical literature suggests that virtual reality is a very potent and effective way of creating distraction. In turn, distraction has been shown to reduce pain and anxiety in children who are receiving painful medical procedures. The pediatric population offers quite a challenge when it comes to pain control, especially the pain caused by medical procedure. Anxiety and anticipation greatly modulates pain perception and can often jeopardize a treatment if a child's collaboration cannot be obtained. With those premises in mind, our team is trying to create an efficient virtual reality game for distracting kids from their pain. The DREAM game has been tailored for the very specific needs and characteristics of our target population. The experience is optimized for the oculus rift and the controls have been simplified to work in various medical settings with minimal preparation time. Our main concern was to create a game that delivers a potent distractive effect while inciting almost no side effects or cyber sickness. The DREAM project is currently being tested on children with burn injuries. The objective of this paper is to present the methodology used to validate our hypotheses.

Development of Cardiovascular Indices of Acute Pain Responding in Infants: A Systematic Review.

Background. Cardiovascular indices of pain are pervasive in the hospital setting. However, no prospective research has examined the development of cardiac responses to acutely painful procedures in the first year of life. Objectives. Our main goal was to synthesize existing evidence regarding the development of cardiovascular responses to acutely painful medical procedures over the first year of life in preterm and term born infants. Methods. A systematic search retrieved 6994 articles to review against inclusion criteria. A total of 41 studies were included in the review. Results. In response to acutely painful procedures, most infants had an increase in mean heart rate (HR) that varied in magnitude both across and within gestational and postnatal ages. Research in the area of HR variability has been inconsistent, limiting conclusions. Conclusions. Longitudinal research is needed to further understand the inherent variability of cardiovascular pain responses across and within gestational and postnatal ages and the causes for the variability.

Locating legacy in illness.

The author, a licensed marriage and family therapist, describes her work with Sofia, an eight-year-old Puerto Rican female with chronic and persistent abdominal pain and leg paralysis with no known organic cause. Sofia's mother, Ana, was also seen by the author. Over the course of several weeks, the family shared stories of painful medical procedures and extreme dietary plans prescribed to them by doctors to identify the etiology of Sofia's illness. Ana described her simultaneous relief and frustration when each test result indicated that there was no organic cause for Sofia's debilitating pain. They talked about the push and pull Ana's family experienced as they prayed simultaneously for abnormal and normal test results. The author told Sofia's pediatrician that she would begin to create a community genogram with the family in their next meeting. She explained that the purpose of the community genogram was to illustrate the social and historical contexts of families' lives. They learned that a seminal narrative in Sofia's family legacy connected deep understanding of others with embodiment of their immediate experience. Sofia's illness became one part of her and her family's legacy and cultural tapestry. Ana described the renewed connections that she and Sofia shared with their family members. As Sofia and Ana spoke with their family members more often, Sofia's leg paralysis and stomach pains decreased. Sofia began attending school regularly and visiting less with her pediatrician. (PsycINFO Database Record

Psychological and Physical Interventions for the Management of Cancer-Related Pain in Pediatric and Young Adult Patients: An Integrative Review.

To identify and appraise current evidence related to the effectiveness of psychological and physical (nonpharmacologic) pain management modalities for children and young adults with cancer . Electronic searches in MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science (from database inception to June 2013) for clinical trials. A total of 32 unique studies were identified. Substantial heterogeneity existed across identified studies, precluding meta-analysis. Therefore, a narrative review of included studies is presented. Studies featured psychological and/or physical pain interventions for children and young adults (N = 1,171) aged 1-21 years with a variety of cancer diagnoses. Interventions included aromatherapy, art therapy, distraction, hypnosis, physical activity, physical positioning, touch therapy, and multimodal cognitive-behavior therapy. Twenty-two studies (69%) reported success in preventing or reducing pain intensity. The level of evidence and methodologic quality of studies were generally low . Current nonpharmacologic pain interventions for pediatric and young adult patients with cancer are diverse. Several modalities significantly decreased pain intensity, suggesting that these strategies may be effective methods of pain treatment, particularly in the case of painful medical procedures. Future well-designed, multicenter, randomized, controlled trials are needed to further discern treatment effects on pain and other health outcomes in this population and to compare the relative effectiveness of different modalities. Nurses play a key role in pain assessment and management in pediatric and young adult patients with cancer. The studies included in this review constitute the beginnings of an evidence base that supports the need to implement psychological and physical interventions to improve pain outcomes in pediatric and young adult patients with cancer.

Effects of Breast Milk and Vanilla Odors on Premature Neonate's Heart Rate and Blood Oxygen Saturation During and After Venipuncture

Different studies have shown that the use of olfactory stimuli during painful medical procedures reduces infants' response to pain. The main purpose of the current study was to investigate the effect of breast milk odor and vanilla odor on premature infants' vital signs including heart rate and blood oxygen saturation during and after venipuncture. A total of 135 preterm infants were randomly selected and divided into three groups of control, vanilla odor, and breast milk odor. Infants in the breast milk group and the vanilla group were exposed to breast milk odor and vanilla odor from 5 minutes prior to sampling until 30 seconds after sampling. The results showed that breast milk odor has a significant effect on the changes of neonatal heart rate and blood oxygen saturation during and after venipuncture and decreased the variability of premature infants' heart rate and blood oxygen saturation. Vanilla odor has no significant effect on premature infants' heart rate and blood oxygen saturation. Breast milk odor can decrease the variability of premature infants' heart rate and blood oxygen saturation during and after venipuncture.

Systematic Review: Predisposing, Precipitating, Perpetuating, and Present Factors Predicting Anticipatory Distress to Painful Medical Procedures in Children.

To conduct a systematic review of the factors predicting anticipatory distress to painful medical procedures in children. A systematic search was conducted to identify studies with factors related to anticipatory distress to painful medical procedures in children aged 0-18 years. The search retrieved 7,088 articles to review against inclusion criteria. A total of 77 studies were included in the review. 31 factors were found to predict anticipatory distress to painful medical procedures in children. A narrative synthesis of the evidence was conducted, and a summary figure is presented. Many factors were elucidated that contribute to the occurrence of anticipatory distress to painful medical procedures. The factors that appear to increase anticipatory distress are child psychopathology, difficult child temperament, parent distress promoting behaviors, parent situational distress, previous pain events, parent anticipation of distress, and parent anxious predisposition. Longitudinal and experimental research is needed to further elucidate these factors.

Using of Distraction Methods on Procedural Pain Management of Pediatric Patients

Medical procedures such as phlebotomy and injections are the most important sources of pain for children. Pain causes children to be frightened of needles and this leads to unwillingness to medical procedures such as vaccine administration, injections and phlebotomy, even may result in neglect or delay in treatment and care. Thus, the nurse should be able to manage painful procedures to reduce emotional and physical effects of painful procedures and to avoid long-term results of pain in children. There are many different approaches to the treatment of procedural pain and anxiety of children during medical procedures, including pharmacological and non-pharmacological methods. In recent years research focusing on nurses’ use of non-pharmacological methods for pain relief of children’s has increased. Present widely used non-pharmacological method for pain relief of children during painful medical procedures is distraction methods. Distraction is a nursing attempt focusing patient’s attention to any other stimulants to control and reduce pain better. The rationale for the pain-reducing effects of distraction hypothesized that the brain has a limited capacity of focusing attention on stimulation. In this article frequently used ditraction method will be discussed

A qualitative analysis of how parents assess acute pain in young children.

An accurate and comprehensive pain assessment is crucial for adequate pain management in pre- and early verbal children during painful medical procedures. This study used an inductive approach to explore the processes involved in parental pain assessment and to develop a new model of Parental Assessment of Acute Child Pain. Participants were 19 parents of children aged under 3 years who had previously or were potentially about to experience an intravenous cannula or nasogastric tube insertion. Parental affect regulation, while witnessing their child in acute pain/distress, appeared to be critical to the processes involved in assessing their child’s pain.

Evaluation of Pain in Healthy Newborns and in Newborns with Developmental Problems (Down Syndrome)

Newborns are often subjected to invasive and painful medical procedures. This happens even more frequently when they require hospitalization. The aim of this paper was to evaluate pain in healthy newborns and in newborns with Down syndrome (DS). We performed a prospective cohort study in the neonatal service of the San Cecilio University Hospital in Granada (Spain) from January 2008 to September 2013. The universe of our study comprised a study group of 20 newborns with DS and a control group of 20 newborns without DS. All of the infants were hospitalized, and thus had to undergo painful medical procedures. The variables studied were basal recovery time (as reflected in crying and the normalization of biological constants), number of punctures, oxygen saturation, heartbeat, blood pressure, response to skin-to-skin contact, and gestational age. The evaluation was performed during blood extraction, vein canalization, and heel puncture. The significant differences in the basal recovery time between the two groups of newborns indicated that those with DS were slower to express pain, and when they did, their response was not as clearly defined as that of babies without DS. The oxygen saturation in babies with DS after the puncture was found to be significantly lower than that of the control group (p < .001). The results of this study revealed that babies with DS were not as quick to perceive pain after a puncture. However, when pain was finally perceived, it persisted for a longer time. This situation should be taken into account in the design of pharmacologic and nonpharmacologic therapies.

Oral glucose and breast milk as a strategy for pain reduction during the heel lance procedure in newborns.

This paper presents the results of a study on pain reduction in newborns that undergo painful medical procedures. This research analyzed the reactions of babies before and after the heel lance procedure, a diagnostic test performed to detect phenylketonuria. This test involved the extraction of a capillary blood sample with a heel lance, a medical procedure that is painful for neonates. The main objective of this research was to evaluate the effectiveness of a 24% oral glucose solution and breastfeeding during heal lance. An experimental study was thus conducted on a sample of 93 newborns in the San Cecilio University Hospital in Granada in 2010. The babies in the sample were divided into three groups, depending on what they ingested during the heal lance. The results obtained showed that there was an association between the difference in HR and the time before the newborn's HR returned to normal after the heel lance (r = 0.562; p = 0.000). Moreover, a positive relation was found between the absolute difference in HR and the difference in oxygen saturation (OS) (r = 0.538; p = 0.000). The OS was found to be greater in the group of newborns that received breast milk.

Parental Distress and Catastrophic Thoughts About Child Pain

Treatment for childhood leukemia requires frequent lumbar punctures (LP) and bone marrow aspirations (BMA), often described by children and parents as more distressing than the disease itself. Findings in schoolchildren and chronic pain samples indicate that increased parental distress may increase parental protective, pain-attending behavior, which is associated with more child pain and distress. However, in the context of invasive medical procedures, it is unknown which parents are likely to become most distressed and engage in pain-attending behavior, and how this impacts the children's experiences. The present study investigated the impact of parental catastrophic thoughts upon parental distress and pain-attending behavior (verbal and nonverbal). Furthermore, the association between parental responses and the children's pain behavior, pain, and distress was examined. A total of 46 parents of children with leukemia (range, 0.6 to 15 y) who underwent a LP/BMA procedure participated in this study. Parental catastrophizing was assessed before and parental and child distress was assessed after the LP/BMA procedure. Parental pain-attending behavior and the child's pain behavior were observed before and after the LP/BMA procedure. Findings indicated that heightened parental catastrophic thinking contributed to increased parental distress during LP/BMA and less pain-attending behavior before the LP/BMA procedure, especially in young children. In contrast, heightened distress in parents with high levels of catastrophizing contributed to increased engagement in postprocedural pain-attending behavior. For young children, increased preprocedural pain-attending behavior was related to more child distress, pain, and pain behavior. The findings demonstrate the importance of parental catastrophic thinking in understanding their caregiving responses and preparing parents and children for painful invasive medical procedures.

Effects of perinatal stress and maternal traumatic stress on the cortisol regulation of preterm infants.

Preterm infants experience intense stress during the perinatal period because they endure painful and intense medical procedures. Repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis during this period may have long-term effects on subsequent cortisol regulation. A premature delivery may also be intensely stressful for the parents, and they may develop symptoms of posttraumatic stress disorder (PTSD). Usable saliva samples were collected (4 times per day over 2 days, in the morning at awakening, at midday, in the afternoon, and in the evening before going to bed) to assess the diurnal cortisol regulation from 46 preterm infants when the infants were 12 months of corrected age (∼ 14 months after birth). Mothers reported their level of PTSD symptoms. The results showed an interaction between perinatal stress and maternal traumatic stress on the diurnal cortisol slope of preterm infants (R(2) = .32). This suggests that the HPA axis of preterm infants exposed to high perinatal stress may be more sensitive to subsequent environmental stress.

The Effect of Vanilla Odor on Response to Venipuncture Pain in Preterm Newborns: a Randomized Control Clinical Trial

Background: Studies have shown that use of olfactory stimuli during painful medical procedures reduces infants’ response to pain. Aim: The main purpose of this study was investigating the effect of vanilla on pain response in preterm infants during and after venipuncture. Methods: This study is a randomized clinical trial. Ninety preterm infants, who were randomly selected and divided into two groups of control and vanilla odor, were classified into 45 people. Infants in the vanilla group were exposed to vanilla odor from 5 minutes before and up to 30 seconds after sampling, and infants of control group were exposed to smell of distilled water. The pain score was measured using premature infant pain profile (PIPP) score 30 seconds prior, during and 30 seconds after sampling. Statistical analyses were done using SPSS 16 software. Analyses were done by t-test, chi-square and repeated measure analyses. Results: Despite the differences between the pain scores of two groups during and after sampling, statistical analyses showed no significant differences between them (p=0.36). Conclusion: Results of the present study showed that use of vanilla odor has no significant effect on premature infants’ pain during blood sampling.