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An Evidence-Based Approach to Minimizing Acute Procedural Pain in the Emergency Department and Beyond. Pediatr Emerg Care 2016; 32:36-42; quiz 43-4. [PMID: 26720064 DOI: 10.1097/pec.0000000000000669] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Painful procedures are common in the ED setting and beyond. Although these procedures are often essential to patient management, they can also be distressing for children, parents, and health providers. As such, it is imperative that effective pain and anxiety-minimizing strategies be used consistently in all settings where painful procedures take place for children. OBJECTIVES This review article aims to provide a summary of several strategies, which are supported by definitive and systematically reviewed evidence, that can be implemented alone or in combination to reduce procedural pain and anxiety for children in the ED and beyond. RESULTS For neonates, breastfeeding, nonnutritive sucking, swaddling, and sucrose administration have all been shown to decrease pain during painful interventions. For neonates, venipuncture is much less painful than heel lance for blood draws. For infants, there is some support for sucrose use. For infants and older children, there is strong evidence for distraction techniques. In addition, the use of fast-acting topical anesthetic creams as an alternative or adjunct to infiltrating anesthetic before laceration repair or vascular access/venipuncture is recommended. Further, buffering of lidocaine can decrease pain during injection. Lastly, if a laceration is amenable to the use of tissue adhesive, this should be preferentially used. CONCLUSIONS In summary, there currently remains a knowledge-to-practice gap in the treatment of children's procedure-related pain. This article has identified multiple age-specific methods to improve the treatment of procedural pain. These simple interventions can improve the care provided to ill and injured children.
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152
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Distraction Using the BUZZY for Children During an IV Insertion. J Pediatr Nurs 2016; 31:64-72. [PMID: 26410385 DOI: 10.1016/j.pedn.2015.07.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 11/21/2022]
Abstract
UNLABELLED Needle pricks are rated by children as their most feared medical event resulting in acute pain, anxiety and distress, which negatively affects both the child and his/her parents. OBJECTIVES To investigate the effects of external cold and vibration via the "BUZZY" on pain ratings of children, their parents and nurses during peripheral IV insertion, to measure the time to a successful IV insertion and to assess the factors that are associated with pain perception of children. METHODS In this randomized control trial (RCT), children between the ages of 4 to 12years were assigned to either an intervention or a control group. The intervention group (n=25) had the "BUZZY" applied during IV insertion while the control group (n=23) did not have the "BUZZY". Children were asked to rate their pain along with their parents and nurses on the Wong-Baker FACES Pain Rating Scale. Time to successful IV insertion and background characteristic of children were assessed and compared. RESULTS Pain scores were significantly lower in the "BUZZY" group for children and the nurses. Time to a successful IV insertion did not differ between groups. Gender, age, previous hospitalization, diagnoses and analgesics were all factors associated with the children's pain scores. However, a multiple regression analysis found that only the "BUZZY" remained a significant predictor of pain scores in children. CLINICAL IMPLICATIONS The "BUZZY" may be an easily accessed, inexpensive ($39.95 each at $0.09 per 3 minute stick), and effective technique to control or reduce pain in young children undergoing IV insertion.
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153
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Flowers SR, Birnie KA. Procedural Preparation and Support as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S694-723. [PMID: 26700922 DOI: 10.1002/pbc.25813] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/28/2015] [Accepted: 09/28/2015] [Indexed: 12/15/2022]
Abstract
Youth with cancer undergo many repeated and invasive medical procedures that are often painful and highly distressing. A systematic review of published research since 1995 identified 65 papers (11 review articles and 54 empirical studies) that investigated preparatory information and psychological interventions for a variety of medical procedures in pediatric cancer. Distraction, combined cognitive-behavioral strategies, and hypnosis were identified as effective for reducing child pain and increasing child coping. Low- to high-quality evidence informed strong recommendations for all youth with cancer to receive developmentally appropriate preparatory information and psychological intervention for invasive medical procedures.
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Affiliation(s)
- Stacy R Flowers
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kathryn A Birnie
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
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154
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Boerner KE, Birnie KA, Chambers CT, Taddio A, McMurtry CM, Noel M, Shah V, Pillai Riddell R. Simple Psychological Interventions for Reducing Pain From Common Needle Procedures in Adults: Systematic Review of Randomized and Quasi-Randomized Controlled Trials. Clin J Pain 2015; 31:S90-8. [PMID: 26352921 PMCID: PMC4900414 DOI: 10.1097/ajp.0000000000000270] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND This systematic review evaluated the effectiveness of simple psychological interventions for managing pain and fear in adults undergoing vaccination or related common needle procedures (ie, venipuncture/venous cannulation). DESIGN/METHODS Databases were searched to identify relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear were prioritized as critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI). RESULTS No studies involving vaccination met inclusion criteria; evidence was drawn from 8 studies of other common needle procedures (eg, venous cannulation, venipuncture) in adults. Two trials evaluating the impact of neutral signaling of the impending procedure (eg, "ready?") as compared with signaling of impending pain (eg, "sharp scratch") demonstrated lower pain when signaled about the procedure (n=199): SMD=-0.97 (95% CI, -1.26, -0.68), after removal of 1 trial where self-reported pain was significantly lower than the other 2 included trials. Two trials evaluated music distraction (n=156) and demonstrated no difference in pain: SMD=0.10 (95% CI, -0.48, 0.27), or fear: SMD=-0.25 (95% CI, -0.61, 0.10). Two trials evaluated visual distraction and demonstrated no difference in pain (n=177): SMD=-0.57 (95% CI, -1.82, 0.68), or fear (n=81): SMD=-0.05 (95% CI, -0.50, 0.40). Two trials evaluating breathing interventions found less pain in intervention groups (n=138): SMD=-0.82 (95% CI, -1.21, -0.43). The quality of evidence across all trials was very low. CONCLUSIONS There are no published studies of simple psychological interventions for vaccination pain in adults. There is some evidence of a benefit from other needle procedures for breathing strategies and neutral signaling of the start of the procedure. There is no evidence for use of music or visual distraction.
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Affiliation(s)
- Katelynn E. Boerner
- Departments of Psychology and Neuroscience, IWK Health Centre
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
| | - Kathryn A. Birnie
- Departments of Psychology and Neuroscience, IWK Health Centre
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
| | - Christine T. Chambers
- Pediatrics and Psychology & Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy
- The Hospital for Sick Children
| | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph
- Children’s Health Research Institute
- Department of Paediatrics, University of Western Ontario, London, ON
| | - Melanie Noel
- Department of Psychology, University of Calgary, AB, Canada
| | - Vibhuti Shah
- Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto
- Mount Sinai Hospital, Toronto, ON
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155
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McMurtry CM, Pillai Riddell R, Taddio A, Racine N, Asmundson GJG, Noel M, Chambers CT, Shah V. Far From "Just a Poke": Common Painful Needle Procedures and the Development of Needle Fear. Clin J Pain 2015; 31:S3-11. [PMID: 26352920 PMCID: PMC4900413 DOI: 10.1097/ajp.0000000000000272] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/14/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vaccine injections are the most common painful needle procedure experienced throughout the lifespan. Many strategies are available to mitigate this pain; however, they are uncommonly utilized, leading to unnecessary pain and suffering. Some individuals develop a high level of fear and subsequent needle procedures are associated with significant distress. OBJECTIVE The present work is part of an update and expansion of a 2009 knowledge synthesis to include the management of vaccine-related pain across the lifespan and the treatment of individuals with high levels of needle fear. This article will provide a conceptual foundation for understanding: (a) painful procedures and their role in the development and maintenance of high levels of fear; (b) treatment strategies for preventing or reducing the experience of pain and the development of fear; and (c) interventions for mitigating high levels of fear once they are established. RESULTS First, the general definitions, lifespan development and functionality, needle procedure-related considerations, and assessment of the following constructs are provided: pain, fear, anxiety, phobia, distress, and vasovagal syncope. Second, the importance of unmitigated pain from needle procedures is highlighted from a developmental perspective. Third, the prevalence, course, etiology, and consequences of high levels of needle fear are described. Finally, the management of needle-related pain and fear are outlined to provide an introduction to the series of systematic reviews in this issue. DISCUSSION Through the body of work in this supplement, the authors aim to provide guidance in how to treat vaccination-related pain and its sequelae, including high levels of needle fear.
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Affiliation(s)
- C Meghan McMurtry
- *Department of Psychology, University of Guelph, Guelph †Children's Health Research Institute ‡Department of Paediatrics, Western University, London §Department of Psychology, York University ∥The Hospital for Sick Children ¶Department of Psychiatry #Leslie Dan Faculty of Pharmacy ¶¶Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto ∥∥Mount Sinai Hospital, Toronto, ON **Department of Psychology, University of Regina, Regina, SK ‡‡Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University §§Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada ††Department of Psychology, University of Calgary, AB, Canada
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156
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Bahorski JS, Hauber RP, Hanks C, Johnson M, Mundy K, Ranner D, Stoutamire B, Gordon G. Mitigating procedural pain during venipuncture in a pediatric population: A randomized factorial study. Int J Nurs Stud 2015; 52:1553-64. [DOI: 10.1016/j.ijnurstu.2015.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 05/12/2015] [Accepted: 05/14/2015] [Indexed: 12/23/2022]
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Birnie KA, Chambers CT, Taddio A, McMurtry CM, Noel M, Pillai Riddell R, Shah V. Psychological Interventions for Vaccine Injections in Children and Adolescents: Systematic Review of Randomized and Quasi-Randomized Controlled Trials. Clin J Pain 2015; 31:S72-89. [PMID: 26348163 PMCID: PMC4900411 DOI: 10.1097/ajp.0000000000000265] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/03/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND This systematic review evaluated the effectiveness of psychological interventions for reducing vaccination pain and related outcomes in children and adolescents. DESIGN/METHODS Database searches identified relevant randomized and quasi-randomized controlled trials. Data were extracted and pooled using established methods. Pain, fear, and distress were considered critically important outcomes. RESULTS Twenty-two studies were included; 2 included adolescents. Findings showed no benefit of false suggestion (n=240) for pain (standardized mean difference [SMD] -0.21 [-0.47, 0.05]) or distress (SMD -0.28 [-0.59, 0.11]), or for use of repeated reassurance (n=82) for pain (SMD -0.18 [-0.92, 0.56]), fear (SMD -0.18 [-0.71, 0.36]), or distress (SMD 0.10 [-0.33, 0.54]). Verbal distraction (n=46) showed reduced distress (SMD -1.22 [-1.87, -0.58]), but not reduced pain (SMD -0.27 [-1.02, 0.47]). Similarly, video distraction (n=328) showed reduced distress (SMD -0.58 [-0.82, -0.34]), but not reduced pain (SMD -0.88 [-1.78, 0.02]) or fear (SMD 0.08 [-0.25, 0.41]). Music distraction demonstrated reduced pain when used with children (n=417) (SMD -0.45 [-0.71, -0.18]), but not with adolescents (n=118) (SMD -0.04 [-0.42, 0.34]). Breathing with a toy (n=368) showed benefit for pain (SMD -0.49 [-0.85, -0.13]), but not fear (SMD -0.60 [-1.22, 0.02]); whereas breathing without a toy (n=136) showed no benefit for pain (SMD -0.27 [-0.61, 0.07]) or fear (SMD -0.36 [-0.86, 0.15]). There was no benefit for a breathing intervention (cough) in children and adolescents (n=136) for pain (SMD -0.17 [-0.41, 0.07]). CONCLUSIONS Psychological interventions with some evidence of benefit in children include: verbal distraction, video distraction, music distraction, and breathing with a toy.
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Affiliation(s)
- Kathryn A Birnie
- Departments of *Psychology and Neuroscience ‡Pediatrics, Dalhousie University †Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS §Leslie Dan Faculty of Pharmacy, University of Toronto ∥The Hospital for Sick Children ‡‡York University §§Mount Sinai Hospital ∥∥Faculty of Medicine, University of Toronto, Toronto ¶Department of Psychology, University of Guelph, Guelph #Children's Health Research Institute **Department of Paediatrics, Western University, London, ON ††Department of Psychology, University of Calgary, AB, Canada
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158
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Cohen LL, Rodrigues NP, Lim CS, Bearden DJ, Welkom JS, Joffe NE, McGrath PJ, Cousins LA. Automated parent-training for preschooler immunization pain relief: a randomized controlled trial. J Pediatr Psychol 2015; 40:526-34. [PMID: 25638483 PMCID: PMC4502392 DOI: 10.1093/jpepsy/jsu162] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/23/2014] [Accepted: 12/28/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To examine a computerized parent training program, "Bear Essentials," to improve parents' knowledge and coaching to help relieve preschoolers' immunization distress. METHOD In a randomized controlled trial, 90 parent-child dyads received Bear Essentials parent training plus distraction, distraction only, or control. Outcomes were parent knowledge, parent and child behavior, and child pain. RESULTS Bear Essentials resulted in improved knowledge of the effects of parents' reassurance, provision of information, and apologizing on children's procedural distress. Trained parents also engaged in less reassurance and more distraction and encouragement of deep breathing. Children in Bear Essentials engaged in more distraction and deep breathing than children in other groups. There were no effects on measures of child distress or pain. CONCLUSIONS Results suggest that the interactive computer training program impacted parent knowledge, parent behavior, and child behavior as hypothesized, but modifications will be necessary to have more robust outcomes on child procedural distress.
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Affiliation(s)
- Lindsey L Cohen
- Department of Psychology, Georgia State University and Capital District Health Authority and IWK Health Centre
| | - Nikita P Rodrigues
- Department of Psychology, Georgia State University and Capital District Health Authority and IWK Health Centre
| | - Crystal S Lim
- Department of Psychology, Georgia State University and Capital District Health Authority and IWK Health Centre
| | - Donald J Bearden
- Department of Psychology, Georgia State University and Capital District Health Authority and IWK Health Centre
| | - Josie S Welkom
- Department of Psychology, Georgia State University and Capital District Health Authority and IWK Health Centre
| | - Naomi E Joffe
- Department of Psychology, Georgia State University and Capital District Health Authority and IWK Health Centre
| | - Patrick J McGrath
- Department of Psychology, Georgia State University and Capital District Health Authority and IWK Health Centre
| | - Laura A Cousins
- Department of Psychology, Georgia State University and Capital District Health Authority and IWK Health Centre
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159
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Taddio A, McMurtry CM. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Paediatr Child Health 2015; 20:195-6. [PMID: 26038636 PMCID: PMC4443825 DOI: 10.1093/pch/20.4.195] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna Taddio
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto
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160
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Palermo TM. Evidence-based interventions in pediatric psychology: progress over the decades. J Pediatr Psychol 2014; 39:753-62. [PMID: 24996921 DOI: 10.1093/jpepsy/jsu048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This introduction to the special issue on Evidence-Based Interventions in Pediatric Psychology provides background on the process used to develop the special issue, a summary of the key findings from the series of reviews, and discussion of the implications for evidence-based practice. Authors followed a three-phase approach to develop their systematic reviews using rigorous systematic review methodology drawn heavily from the Cochrane Collaboration. The strength of the evidence for each pediatric psychology intervention was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The introduction discusses the progress that has been made in the evidence base for pediatric psychology interventions since the first special series published in 1999. Recommendations to stimulate further research and expand and strengthen the quality of the evidence base are described. The introduction concludes with implications from the special issue for pediatric psychology training in evidence-based practice.
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Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington and Seattle Children's Research Institute
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