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Alzubaidi MA, Drummond BK, Wu J, Jones A, Aggarwal VR. Interventions to Reduce Intra-Operative and Post-Operative Pain Associated with Routine Dental Procedures in Children: A Systematic Review and Meta-Analysis. Dent J (Basel) 2024; 12:163. [PMID: 38920864 DOI: 10.3390/dj12060163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE implementing appropriate pharmacological and non-pharmacological interventions to alleviate pain related to routine dental procedures in paediatric patients could enhance children's ability to manage dental care. The aim of this review was to investigate the effectiveness of and provide recommendations for interventions that can be used to reduce intra-operative and post-operative pain associated with routine paediatric dental procedures. METHODS A systematic review of randomised controlled clinical trials (RCT) was conducted. Multiple electronic databases were systematically searched. The Cochrane risk-of-bias tool for RCTs was used to evaluate the quality of the included studies. A meta-analysis was performed to determine the effectiveness of the interventions using the Cohen's d standardised mean differences (SMD) and 95% confidence intervals (CIs) for continuous outcomes. The GRADE tool was used to assess the certainty of evidence to make recommendations. RESULTS The review included forty-five RCTs comprising 3093 children. Thirty-seven RCTs were included in the meta-analysis, which showed the effectiveness of behavioural interventions (SMD = -0.50, 95% CI -0.83 to -0.18), mechanoreceptor and thermal receptor stimulation (SMD = -1.38, 95% CI -2.02 to -0.73) for intra-operative pain, and pre-emptive oral analgesics (SMD = -0.77, 95% CI -1.21 to -0.33) for reducing post-operative pain in children receiving routine dental care. CONCLUSION The GRADE results for these interventions were strong recommendation (IB) for their use, based on moderate evidence and their benefits far outweighing the harm, and they can be delivered readily with minimal training to reduce the pain experience of paediatric patients.
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Affiliation(s)
- Mohammed A Alzubaidi
- Department of Preventive Dentistry, Faculty of Dentistry, Taif University, Taif 21944, Saudi Arabia
| | - Bernadette K Drummond
- Faculty of Medicine & Health, School of Dentistry, University of Leeds, Leeds LS2 9JT, UK
| | - Jianhua Wu
- Faculty of Medicine & Health, School of Dentistry, University of Leeds, Leeds LS2 9JT, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London E1 4NS, UK
| | - Adam Jones
- Faculty of Medicine & Health, School of Dentistry, University of Leeds, Leeds LS2 9JT, UK
| | - Vishal R Aggarwal
- Faculty of Medicine & Health, School of Dentistry, University of Leeds, Leeds LS2 9JT, UK
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Almarzouq SSFS, Chua H, Yiu CKY, Lam PPY. Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:537. [PMID: 38470648 PMCID: PMC10931341 DOI: 10.3390/healthcare12050537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Non-pharmacological behavioural interventions (NPBIs) have been employed by dentists to alleviate dental fear and anxiety (DFA) among preschool and school children. The aim of this systematic review and meta-analysis was to investigate the effectiveness of different NPBIs in reducing DFA among children aged below 12. METHOD A comprehensive search was conducted using four electronic databases to identify randomised controlled trials that assess the effectiveness of NPBIs among preschool and school children. Two reviewers independently screened and selected the relevant studies, evaluated the risk of bias, and extracted relevant data for qualitative and quantitative syntheses. RESULT A total of 66 articles were included in the study. Except during more invasive dental procedures, the use of distraction techniques was found to result in significantly lower self-rated anxiety, better cooperation, and lower pulse rate compared to the tell-show-do method. However, inconsistent results were reported regarding the efficacy of virtual reality, modelling, visual pedagogies, tell-show-do and other NPBIs in reducing DFA among children. CONCLUSIONS The studies exhibited substantial heterogeneity due to varying age groups, methods of implementing NPBIs, dental treatments performed, and measurement scales employed in the evaluation of DFA.
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Affiliation(s)
| | - Helene Chua
- National Healthcare Group Polyclinics, Singapore 308433, Singapore
| | - Cynthia K. Y. Yiu
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong (C.K.Y.Y.)
| | - Phoebe P. Y. Lam
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong (C.K.Y.Y.)
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Mustafa MS, Shafique MA, Zaidi SDEZ, Qamber A, Rangwala BS, Ahmed A, Zaidi SMF, Rangwala HS, Uddin MMN, Ali M, Siddiq MA, Haseeb A. Preoperative anxiety management in pediatric patients: a systemic review and meta-analysis of randomized controlled trials on the efficacy of distraction techniques. Front Pediatr 2024; 12:1353508. [PMID: 38440185 PMCID: PMC10909818 DOI: 10.3389/fped.2024.1353508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/09/2024] [Indexed: 03/06/2024] Open
Abstract
Background This study addresses the pervasive issue of heightened preoperative anxiety in healthcare, particularly among pediatric patients. Recognizing the various sources of anxiety, we explored both pharmacological and nonpharmacological interventions. Focusing on distraction techniques, including active and passive forms, our meta-analysis aimed to provide comprehensive insights into their impact on preoperative anxiety in pediatric patients. Methods Following the PRISMA and Cochrane guidelines, this meta-analysis and systematic review assessed the efficacy of pharmaceutical and distraction interventions in reducing pain and anxiety in pediatric surgery. This study was registered on PROSPERO (CRD42023449979). Results This meta-analysis, comprising 45 studies, investigated pharmaceutical interventions and distraction tactics in pediatric surgery. Risk of bias assessment revealed undisclosed risks in performance and detection bias. Distraction interventions significantly reduced preoperative anxiety compared to control groups, with notable heterogeneity. Comparison with Midazolam favored distraction techniques. Subgroup analysis highlighted varied efficacies among distraction methods, with a notable reduction in anxiety levels. Sensitivity analysis indicated stable results. However, publication bias was observed, suggesting a potential reporting bias. Conclusion Our study confirms distraction techniques as safe and effective for reducing pediatric preoperative anxiety, offering a valuable alternative to pharmacological interventions. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=449979, PROSPERO [CRD42023449979].
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Affiliation(s)
| | | | | | - Amna Qamber
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Aftab Ahmed
- Department of Paediatrics, National Institute of Child Health, Karachi, Pakistan
| | | | | | | | - Mirha Ali
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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Geagea D, Tyack Z, Kimble R, Polito V, Ayoub B, Terhune DB, Griffin B. Clinical Hypnosis for Procedural Pain and Distress in Children: A Scoping Review. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:661-702. [PMID: 36448690 PMCID: PMC10233484 DOI: 10.1093/pm/pnac186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 07/25/2023]
Abstract
OBJECTIVE Pain and distress are common in children undergoing medical procedures, exposing them to acute and chronic biopsychosocial impairments if inadequately treated. Clinical hypnosis has emerged as a potentially beneficial treatment for children's procedural pain and distress due to evidence of effectiveness and potential superiority to other psychological interventions. However, systematic reviews of clinical hypnosis for children's procedural pain and distress have been predominantly conducted in children undergoing oncology and needle procedures and are lacking in broader pediatric contexts. This scoping review maps the evidence of clinical hypnosis for children's procedural pain and distress across broad pediatric contexts while highlighting knowledge gaps and areas requiring further investigation. METHODS Published databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus, and Web of Science) and grey literature were searched in addition to hand-searching reference lists and key journals (up to May 2022). Two independent reviewers screened the titles and abstracts of search results followed by a full-text review against eligibility criteria. Articles were included if they involved a clinical hypnosis intervention comprising an induction followed by therapeutic suggestions for pain and distress in children undergoing medical procedures. This review followed the Arksey and O'Malley (2005) methodology and incorporated additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS A total of 38 eligible studies involving 2,205 children were included after 4,775 articles were screened. Research on clinical hypnosis for children's procedural pain and distress was marked by a lack of fidelity measures and qualitative data as well as by inadequate intervention reporting and high attrition rates. Evidence regarding the safety of clinical hypnosis, pain unpleasantness outcomes, factors influencing outcomes, as well as barriers and facilitators to implementing hypnosis and study procedures was also lacking. Clinical hypnosis has potential benefits for children's procedural pain and distress based on evidence of superiority to control conditions and nonpharmacological interventions (e.g., distraction, acupressure) with moderate to large effect sizes as reported in 76% of studies. However, heterogeneous interventions, contexts, study designs, and populations were identified, and the certainty of the evidence was not evaluated. CONCLUSIONS The review suggests potential benefits of clinical hypnosis for children's procedural pain and distress and thus provides a precursor for further systematic reviews and trials investigating the effectiveness of clinical hypnosis. The review also indicates the need to further explore the feasibility, acceptability, implementation, and safety of clinical hypnosis in children undergoing painful procedures. Based on the review, researchers implementing clinical hypnosis should adequately report interventions or use treatment manuals, follow recommended research guidelines, and assess the fidelity of intervention delivery to promote replicating and comparing interventions. The review also highlights common methodological shortcomings of published trials to avoid, such as the lack of implementation frameworks, small sample sizes, inadequate reporting of standard care or control conditions, and limited evidence on pain unpleasantness outcomes.
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Affiliation(s)
- Dali Geagea
- Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia
| | - Zephanie Tyack
- Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia
- Australian Centre for Health Service Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, The University of Queensland, Brisbane, Australia
| | - Vince Polito
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Bassel Ayoub
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Devin B Terhune
- Department of Psychology, Goldsmiths University of London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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ADV6209 for Premedication in Pediatric Anesthesia: A Double-Blinded, Randomized Controlled Trial. Pharmaceutics 2022; 14:pharmaceutics14102062. [DOI: 10.3390/pharmaceutics14102062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
ADV6209, a new formulation of midazolam with the addition of γ-cyclodextrin for oral use, has recently been licensed as the first pediatric sedative in the European Union. We compared the clinical efficacy of ADV6209 to the standard formulation of midazolam in premedication to reduce anxiety in children before anesthesia induction in a randomized, double-blinded controlled trial. Eighty children (ASA I/II; age: 2–8 years) scheduled for elective surgery were randomized to receive 0.25 mg kg−1 of either conventional midazolam or ADV6209. Assessment tools included the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) as well as scores for oral acceptance of the premedication and facemask acceptance during inhalational anesthesia induction. Mann–Whitney U and Pearson’s chi-square tests were used for comparisons of outcome parameters. The primary outcome parameter of the study (mYPAS-SF anxiety score 30 min after the drug administration) did not reveal any significant intergroup difference between the ADV6209 group and the conventional midazolam group. Both drugs revealed their efficacy in reducing anxiety and in providing adequate sedation. The premedication dose was accepted by all children in the ADV6209 but rejected by 15% in the conventional midazolam group (p = 0.037). Acceptance of facemask placement was not found to differ significantly. No adverse events related to the study medications were noted. ADV6209 was better orally accepted than the conventional midazolam preparation and proved its efficacy in reducing preoperative anxiety. This clinically interesting preparation may alleviate the premedication process of 2−8 year-old children and obviates off-label drug use.
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Hypnosis on acute dental and maxillofacial pain relief: A systematic review and meta-analysis. J Dent 2022; 123:104184. [PMID: 35691451 DOI: 10.1016/j.jdent.2022.104184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION/OBJECTIVES The effects of hypnosis on acute pain have been discussed recently, resulting in increased attention in the dental/maxillofacial field offering new perspectives, especially in emergency situations, trauma, or acute inflammatory situations where conventional pharmaceuticals are contraindicated due to allergies or intolerance reactions. DATA To systematically evaluate and assess the effects of hypnosis on acute dental/facial pain relief. Randomized controlled trials, cohort studies, controlled clinical trials, cross-sectional studies, evaluation, and validation studies, following the PRISMA guidelines, of human subjects of all ages were included. SOURCES Five electronic databases (Cochrane, Embase, MEDLINE via PubMed, LILACS, Scopus) were screened for studies published between 1989 - 2021. A NIH quality-assessment-tool was performed. STUDY SELECTION/RESULTS 27 papers have been included and a meta-analysis was performed. Hypnosis has been reported to reduce intraoperative and postoperative pain as well as the use of analgesics in various dental procedures such as tooth extraction. Highly hypnotizable subjects generally respond better to hypnosis. Different hypnosis techniques were used for pain relief and relaxation. The studies show a large heterogeneity. CONCLUSION Although there are only a small number of studies on the subject so far, evidence can be confirmed for the effects of hypnosis on acute pain relief in dental/maxillofacial area. Despite the promising results, further research is needed. CLINICAL SIGNIFICANCE Hypnosis offers a possible alternative to conventional pain medications for acute dental and maxillofacial pain, especially in cases of allergies or contraindications; it can be easily applied by a trained practitioner.
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Rienhoff S, Splieth CH, Veerkamp JSJ, Rienhoff J, Krikken JB, Campus G, Wolf TG. Hypnosis and Sedation for Anxious Children Undergoing Dental Treatment: A Retrospective Practice-Based Longitudinal Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050611. [PMID: 35626788 PMCID: PMC9139918 DOI: 10.3390/children9050611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/05/2022] [Accepted: 04/21/2022] [Indexed: 12/11/2022]
Abstract
To assess whether the treatment of children with oral midazolam and pediatric hypnosis techniques can improve the compliance in consecutive sessions, a retrospective longitudinal practice-based observational study was designed and carried out. A total of 311 children between 3 and 12 years of age were treated under hypnosis and sedation with midazolam (0.40 mg/kg body weight). Treatments were performed in one to a maximum of three sessions. A total of 183 children received one, 103 received two and 25 children received three treatment sessions. The behavior of the children during the sessions was examined by means of the Venham score. The self-evaluation of the children was based on the Wong−Baker Scale. Child behavior using midazolam and hypnosis techniques showed little difference and good compliance between the sessions. Venham scores did not increase significantly regarding total treatment from the first (0.99 ± 1.41) to the second (1.17 ± 1.39) and to the third session (1.27 ± 1.20) (p > 0.05). However, considering the highest Venham scores that occurred in each case, the behavior of the children worsened significantly (p < 0.01) during the three treatment sessions, from 1.37 ± 1.31 (first) to 1.87 ± 1.74 (second) to 2.32 ± 1.33 (third). In 6.11% of the children, treatment was discontinued in the first session (n = 19), 0.96% in the second (n = 3) and 0% in the third. Treatment with low-dose midazolam, combined with hypnosis techniques, showed to be an effective option for dental treatment in children. Within the limitations of the current study, and with consideration of highest possible compliance, no more than two treatment sessions for pediatric dental treatment should be performed.
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Affiliation(s)
- Sabine Rienhoff
- Pediatric Dental Practice, D-30177 Hannover, Germany; (S.R.); (J.R.)
| | - Christian H. Splieth
- Department of Preventive and Pediatric Dentistry, Center for Oral Health, Ernst Moritz Arndt University Greifswald, D-17475 Greifswald, Germany;
| | | | - Jan Rienhoff
- Pediatric Dental Practice, D-30177 Hannover, Germany; (S.R.); (J.R.)
| | - Janneke B. Krikken
- Snoet Kindermondzorgcentrum, Pediatric Dental Practice, NL-1061 Amsterdam, The Netherlands;
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland;
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, I-07100 Sassari, Italy
- Correspondence: ; Tel.: +41-31-632-2580
| | - Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland;
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, D-55131 Mainz, Germany
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Wang R, Huang X, Wang Y, Akbari M. Non-pharmacologic Approaches in Preoperative Anxiety, a Comprehensive Review. Front Public Health 2022; 10:854673. [PMID: 35480569 PMCID: PMC9035831 DOI: 10.3389/fpubh.2022.854673] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/14/2022] [Indexed: 02/03/2023] Open
Abstract
During the pre-operation period, surgical candidates experience situations that stimulate psychological anxiety leading to stress during and after surgery which is known as preoperative anxiety. This condition can cause psychological and physiological adverse effects on both children and adults. Due to the high prevalence and adverse effects of preoperative anxiety, different treatments have been evaluated including pharmacological and non-pharmacological approaches. As pharmacological treatments may cause adverse effects such as breathing problems, drowsiness, interfering with anesthetic drugs, and prolonged recovery, non-pharmacological interventions are becoming more popular. These methods include cognitive-behavioral therapy, music therapy, pre-op preparation video, aromatherapy, hypnosis, guided imagery relaxation therapy, and massage. In this study, the most popular non-pharmacological approaches to preoperative anxiety are reviewed focusing on more recent evidence provided by clinical studies. The reviewed clinical evidence on the mentioned methods shows the efficacy of non-pharmacological interventions for the treatment of preoperative anxiety, so they can be used in patients of different ages and types of disease and surgery.
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Affiliation(s)
- Rulin Wang
- Medical College, Xijing University, Xi'an, China
| | - Xin Huang
- Department of Psychiatry, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Wang
- Department of Psychiatry, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yuan Wang
| | - Masod Akbari
- Research Center for Psychiatric Diseases, Tehran University of Medical Sciences, Tehran, Iran
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Erappa U, Konde S, Agarwal M, Peethambar P, Devi V, Ghosh S. Comparative Evaluation of Efficacy of Hypnosis, Acupressure and Audiovisual Aids in Reducing the Anxiety of Children during Administration of Local Anesthesia. Int J Clin Pediatr Dent 2022; 14:S186-S192. [PMID: 35645487 PMCID: PMC9108796 DOI: 10.5005/jp-journals-10005-2113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The present study aimed to assess and compare the efficacy of acupressure, hypnosis and audiovisual aids in reducing anxiety in children during the administration of local anesthesia (LA). Methodology Two hundred apparently healthy children were selected randomly between 6 and 10 years of age and were divided into 4 groups with 50 children in each group. Group I: children were subjected to hypnosis, group II: acupressure, group III: AV aids i.e., VPT, and group IV: children were the control group where no anxiety-reducing techniques were used during administration of LA. The anxiety scores were recorded at three different time intervals by recording the pulse rate (PR), respiratory rate (RR) and anxiety rate (AR) and subjected to statistical analysis. Results The results showed that, all the three distraction techniques showed a significant reduction in PR, RR and AR at all time intervals, when compared to the control group. A significant reduction in PR, RR and AR was seen in the hypnosis group when compared to acupressure and only PR in comparison to AV aids. There was no significant difference between group II and III in reducing anxiety. Conclusion The present study indicates that all the three distraction techniques were effective in reducing anxiety in children. Hypnosis was most promising, followed by audiovisual aids and acupressure. Clinical significance The techniques can be utilized in a day-to-day practice to manage patients with anxiety. How to cite this article Erappa U, Konde S, Agarwal M, et al. Comparative Evaluation of Efficacy of Hypnosis, Acupressure and Audiovisual Aids in Reducing the Anxiety of Children during Administration of Local Anesthesia. Int J Clin Pediatr Dent 2021;14(S-2):S186-S192.
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Affiliation(s)
- Umadevi Erappa
- Department of Pediatric and Preventive Dentistry, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India
- Umadevi Erappa, Department of Pediatric and Preventive Dentistry, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India, Phone: +91 9632530566, e-mail:
| | - Sapna Konde
- Department of Pedodontics, AECS Maaruti College of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Manisha Agarwal
- Department of Pedodontics, AECS Maaruti College of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Preetha Peethambar
- Department of Pedodontics and Preventive Dentistry, AECS Maaruti College of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
| | - V Devi
- Department of Pedodontics, Vishnu Dental College, Bengaluru, Karnataka, India
| | - Suryoday Ghosh
- Department of Pediatric and Preventive Dentistry, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India
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Sine H, Achbani A, Filali K. The Effect of Hypnosis on the Intensity of Pain and Anxiety in Cancer Patients: A Systematic Review of Controlled Experimental Trials. Cancer Invest 2021; 40:235-253. [PMID: 34698595 DOI: 10.1080/07357907.2021.1998520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pain is a common symptom in cancer patients. Hypnosis is considered one of the most recognized non-pharmacological techniques in pain management. In oncology, this technique can be used as a complementary treatment to reduce the level of pain and anxiety. The objective of this study is to systematically review and evaluate controlled clinical trials (CCTs) examining the effect of hypnosis on the intensity of pain, and anxiety in cancer patients. METHODS A systematic review was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analyses" (PRISMA). The Cochrane systematic review database, the abstract databases, Scopus, PubMed, Google Scholar, and Cochrane Library have been systematically reviewed from 2005 to 2018. RESULTS Eleven CCT with a total of 1182 participants met the inclusion criteria and were included in this review. The participants were mainly women (n = 968). Their average age alternates between 48 and 58 years. Perceived pain was measured primarily by visual analog scale (VAS)/numerical pain rating scale (NPRS), which showed that anxiety was measured by Hospital Anxiety and Depression scale (HADS). Hypnosis-related anxiety and pain decreased significantly with respect to usual treatment. CONCLUSIONS Evidence suggests promising results of hypnosis on the management of pain, and anxiety levels in the vast majority of cancer patients. Therefore, because of the exploratory design and high risk of bias, the effectiveness of hypnosis or hypnotherapy in reducing pain and anxiety levels remains unclear. There is a need for more rigorous randomized controlled trials (RCTs).
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Affiliation(s)
- Hayat Sine
- Clinical Epidemiology and Medico-Surgical Sciences, Faculty of Medicine and Pharmacy, Mohammed V-Rabat University, Rabat, Morocco
| | - Abderrahmane Achbani
- Department of Biology, Faculty of Sciences, Laboratory of Cell Biology and Molecular Genetics, University Ibn Zohr, Agadir, Morocco.,Higher Institute of Nursing Professions and Health Techniques, Marrakech, Morocco
| | - Karim Filali
- Clinical Epidemiology and Medico-Surgical Sciences, Faculty of Medicine and Pharmacy, Mohammed V-Rabat University, Rabat, Morocco
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Milling LS, Valentine KE, LoStimolo LM, Nett AM, McCarley HS. Hypnosis and the Alleviation of Clinical Pain: A Comprehensive Meta-Analysis. Int J Clin Exp Hypn 2021; 69:297-322. [PMID: 34038322 DOI: 10.1080/00207144.2021.1920330] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This is the first comprehensive meta-analysis in approximately 20 years of all controlled studies of the use of hypnosis for relieving clinical pain. To be included, studies were required to utilize a between-subjects or mixed model design in which a hypnosis intervention was compared with a control condition in alleviating any form of clinical pain. Of 523 records screened, 42 studies incorporating 45 trials of hypnosis met the inclusion criteria. Our most conservative estimates of the impact of hypnosis on pain yielded mean weighted effect sizes of 0.60 (p ≤ .001) for 40 post trials and 0.61 (p ≤ .001) for 9 follow-up trials. These effect sizes fall in the medium range according to Cohen's guideline and suggest the average participant receiving hypnosis reduced pain more than about 73% of control participants. Hypnosis was moderated by the overall methodological quality of trials-the mean weighted effect size of the 19 post trials without high risk ratings on any of the Cochrane Risk of Bias dimensions was 0.77 (p ≤ .001). Hypnosis was also moderated by hypnotic suggestibility, with 6 post trials producing a mean weighted effect size of r = 0.53 (p ≤ .001). Our findings strengthen the assertion that hypnosis is a very efficacious intervention for alleviating clinical pain.
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Affiliation(s)
- Leonard S Milling
- Department of Psychology, University of Hartford, West Hartford, Connecticut, USA
| | - Keara E Valentine
- Department of Psychology, University of Hartford, West Hartford, Connecticut, USA
| | - Lindsey M LoStimolo
- Department of Psychology, University of Hartford, West Hartford, Connecticut, USA
| | - Alyssa M Nett
- Department of Psychology, University of Hartford, West Hartford, Connecticut, USA
| | - Hannah S McCarley
- Department of Psychology, University of Hartford, West Hartford, Connecticut, USA
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Venkiteswaran A, Tandon S. Role of Hypnosis in Dental Treatment: A Narrative Review. J Int Soc Prev Community Dent 2021; 11:115-124. [PMID: 34036071 PMCID: PMC8118047 DOI: 10.4103/jispcd.jispcd_320_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 11/04/2022] Open
Abstract
Aim This narrative aims to outline the use of hypnosis in managing dental anxiety in during dental treatment. The PICO used to answer the objectives are (P) dental patients, (I) hypnosis, (C) conventional behaviour management techniques & (O) reduced pain/anxiety. Materials and Methods An electronic search of three databases; PubMed, Scopus and EBSCOhost was conducted using the keywords "hypnosis or hypnotherapy" AND "dentistry or dental" between the year 2000 and 2020. A total of 19 studies were selected based on eligibility. Data extracted were study subject, design of study, parameters used to assess, type of hypnosis script used and the study outcome. Results The studies show that hypnosis is effective in pain management and dental anxiety. It can also be used for improving compliance in patients who are wearing orthodontic appliances (Trakyali et al, 2008) and reducing salivary flow during dental treatment (Satlz et al, 2014). Conclusion Hypnosis has the potential to be a useful tool in the management of children and adults.
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Affiliation(s)
- Annapurny Venkiteswaran
- Centre Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| | - Shobha Tandon
- Department of Paediatric Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Arabzade Moghadam S, Yousefi F, Saad S. The effect of hypnosis on pain relief due to injection of dental infiltration anesthesia. Clin Exp Dent Res 2021; 7:399-405. [PMID: 33826241 PMCID: PMC8204039 DOI: 10.1002/cre2.356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 10/11/2020] [Accepted: 10/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background and objective Dental patients often experience the fear of pain induced by injectable anesthesia. This study aimed to investigate the impact of hypnosis on relieving the pain of injected dental infiltration anesthesia. Materials and methods This single‐blind clinical trial was conducted on 32 healthy volunteers to assess the pain perception in mucosal injection. The visual analog scale was applied for the measurement of one‐sided pain intensity in the maxilla without hypnosis. When hypnosis was implemented, the same procedure was performed on the other side of the maxilla reversely within one session. Results Hypnosis implementation significantly decreased the intensity of the perceived pain before anesthesia injection (p = 0.05). Conclusion Hypnosis before the injection of dental infiltration anesthesia could decrease the pain intensity caused by the injection. Therefore, hypnosis therapy is recommended as an effective approach to pain control for anesthesia injection.
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Affiliation(s)
- Soma Arabzade Moghadam
- Pediatric Dentistry School of Dentistry, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fayegh Yousefi
- Neurosciences Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sahand Saad
- Kurdistan University of Medical Sciences, Sanandaj, Iran
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Sabherwal P, Kalra N, Tyagi R, Khatri A, Srivastava S. Hypnosis and progressive muscle relaxation for anxiolysis and pain control during extraction procedure in 8-12-year-old children: a randomized control trial. Eur Arch Paediatr Dent 2021; 22:823-832. [PMID: 33782879 PMCID: PMC8006876 DOI: 10.1007/s40368-021-00619-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
Introduction Hypnosis (H) and Progressive Muscle Relaxation (PMR) have proven to be effective in a variety of medical settings; there is a paucity of their practical application in paediatric dentistry. The study aimed to comparatively evaluate the role of H and PMR on anxiety, heart rate (HR), oxygen saturation (SPO2), blood pressure (BP), pain, and analgesic requirement during extraction in children. Materials and methods Sixty children aged 8–12 years undergoing primary molar extractions were randomly allocated to three groups—H, PMR, and control (C). The anxiety (proposed Visual Facial Anxiety scale), HR, and SPO2 were measured pre/post-operatively with/without interventions (H, PMR, C) at 4 intervals. The BP and pain (Wong-Baker faces pain scale) were recorded pre- and post-operatively. Need for analgesic post-operatively was assessed. Results Statistically significant reduction in anxiety was noted post-extraction in H (0.30 ± 0.80), PMR (0.50 ± 0.69) (p < 0.001*). HR showed a statistically significant drop after H, PMR application. (p < 0.001*) No significant difference in SPO2 was noted in the three groups (p > 0.05). Pain control was well achieved using H (85%), PMR (70%); BP was well-regulated in the H, PMR compared to C group (p < 0.001*). Need for analgesics was reduced in H (45%), PMR (50%) versus C (100%). Both techniques H, PMR were comparable in all measures. Conclusion Hypnosis and PMR are effective techniques for anxiolysis and pain control in paediatric dental patients.
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Affiliation(s)
- P Sabherwal
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital University of Delhi, New Delhi, 110095, Delhi, India
| | - N Kalra
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital University of Delhi, New Delhi, 110095, Delhi, India.
| | - R Tyagi
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital University of Delhi, New Delhi, 110095, Delhi, India
| | - A Khatri
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital University of Delhi, New Delhi, 110095, Delhi, India
| | - S Srivastava
- Department of Psychiatry, University College of Medical Sciences, Guru Teg Bahadur Hospital University of Delhi, New Delhi, 110095, Delhi, India
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Wolf TG, Kellerhoff KN, Schmierer A, Schmierer G, Halsband U. Caries treatment in a four-year-old boy using hypnosis - a case report. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2021; 63:217-228. [PMID: 33617427 DOI: 10.1080/00029157.2020.1797624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This clinical case report demonstrates the successful application of hypnosis in an anxious four-year-old boy in whom two primary molars were treated with a composite filling. The almost 16-minute pediatric dental treatment was performed without complications and without interruptions. It could be shown that hypnosis can be used for the pediatric dental treatment of decayed primary tooth lesions. In the specific individual case hypnosis was not only used adjuvant but as an alternative to local anesthesia. A dental anxiety reducing effect and an elimination of pain perception were observed, so that the treatment was possible without anesthesia. It was also found that the communication and rapport between the practitioner and the four-year-old child were improved using hypnosis. There is still a need for high quality studies on the numerous positive effects that hypnosis has on pediatric dental treatment.
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Affiliation(s)
- Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katharina Nadja Kellerhoff
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Albrecht Schmierer
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Gudrun Schmierer
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Ulrike Halsband
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
- Department of Psychology, Neuropsychology, University of Freiburg, Germany
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Topalel S, Orekici Temel G, Azizoğlu M. Evaluation of Preoperative Anxiety in Turkish Paediatric Patients and Validity and Reliability of the Turkish Modified Yale Preoperative Anxiety Scale. Turk J Anaesthesiol Reanim 2020; 48:484-490. [PMID: 33313588 PMCID: PMC7720823 DOI: 10.5152/tjar.2020.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Preoperative anxiety has been related with postoperative behaviour changes, and it is characterised by subjective feelings. The modified Yale Preoperative Anxiety Scale (mYPAS) is a tool, which indicates preoperative anxiety in children older than 2 years. The objective of this study was to investigate factors affecting the level of preoperative anxiety after conduct validity and reliability of the Turkish version of mYPAS. Methods After obtaining approval from the ethics committee, 330 children aged 5-16 years were included in the study. Relationships between possible anxiety factors and anxiety levels were evaluated after validity and interrater reliability of the Turkish version. Results The intraclass correlation coefficient between the three observers was 0.9949 (95% confidence interval [CI]: 0.9939-0.9958) for the playroom assessments and 0.9952 (95% CI: 0.9942-0.9960) for the operating room assessments. The anxiety level was significantly lower in premedicated patients (p<0.001). There was a negative correlation between age and anxiety level (p<0.001, r=-0.350). Conclusion The Turkish version of mYPAS has high validity and reliability and is suitable for use in the paediatric population of our country. Premedication significantly decreased preoperative anxiety, and younger patients tended to have higher anxiety level. For the 5-12 years age range, the level of anxiety decreased with age. More clinical studies are needed to investigate factors that contribute to preoperative anxiety.
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Affiliation(s)
- Selen Topalel
- Department of Anaesthesiology and Reanimation, Bingöl State Hospital, Bingöl, Turkey
| | - Gülhan Orekici Temel
- Department of Biostatistics and Bioinformatics, Mersin University School of Medicine, Mersin, Turkey
| | - Mustafa Azizoğlu
- Department of Anaesthesiology and Reanimation, Mersin University School of Medicine, Mersin, Turkey
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Tezcan B, Ademoğlu D, Can M, Kazancı D, Mungan İ, Taştemur S, Ceylan C, Turan S. A Randomized Clinical Trial on the Effect of Hypnosis on Anxiety and Pain in Rigid Cystoscopy Patients. J Endourol 2020; 35:47-53. [PMID: 32867544 DOI: 10.1089/end.2020.0101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cystoscopy is one of the most common procedures in outpatient urology. Although flexible cystoscopes are more tolerable, rigid cystoscopes have still been used in many clinics because of their lower costs, better visual performance, and easier handling. It can be difficult to achieve optimal relief of pain and anxiety during rigid cystoscopy. The aim of the present prospective randomized study was to evaluate the efficacy of hypnosis as an adjunct to routine local anesthesia in reducing pain and anxiety in rigid cystoscopy patients. Materials and Methods: Ninety male patients undergoing rigid cystoscopy for the first time were randomized into two groups: (1) Hypnosis Group (Group H) patients underwent cystoscopy with hypnotic communication as an adjuvant approach for periprocedural analgesia and anxiety, (2) Standard Care Group (Group SC) patients underwent cystoscopy with routine local anesthesia and lubrication as control group. The data were collected using visual analog scale (VAS) for pain, State-Trait Anxiety Inventory (STAI) for anxiety and hemodynamic parameters. Furthermore, a VAS was also completed by the urologist to assess his satisfaction. Results: Baseline characteristics, STAI, hemodynamic parameters, and recovery duration were statistically similar between the two groups. The procedure duration was shorter in Group H (p = 0.018). The postprocedural STAI and VAS scores of patients in Group H were significantly lower than those of Group SC (p = 0.006; p = 0.02, respectively). Heart rate and mean arterial pressure after positioning of the patient (p = 0.000; p = 0.004, respectively) and insertion of the cystoscope (p = 0.000; p = 0.000) were statistically lower in Group H, whereas baseline, postprocedural, and predischarge hemodynamic measurements were similar. Urologists were also more satisfied in Group H (p = 0.000). Conclusion: Hypnosis as an adjunct therapy to local anesthesia during rigid cystoscopy significantly reduces pain and anxiety, provides more stable hemodynamic conditions, shortens procedure duration, and thus appears attractive for pain and anxiety management.
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Affiliation(s)
- Büşra Tezcan
- Intensive Care Clinic, Ankara City Hospital, Ankara, Turkey
| | - Derya Ademoğlu
- Intensive Care Clinic, İstanbul Başakşehir City Hospital, İstanbul, Turkey
| | - Müçteba Can
- Intensive Care Clinic, Ankara City Hospital, Ankara, Turkey
| | - Dilek Kazancı
- Intensive Care Clinic, Ankara City Hospital, Ankara, Turkey
| | - İbrahim Mungan
- Intensive Care Clinic, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Sedat Taştemur
- Department of Urology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Cavit Ceylan
- Department of Urology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Sema Turan
- Intensive Care Clinic, Ankara City Hospital, Ankara, Turkey
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Pieczynski J, Cosio D, Pierce W, Serpa JG. Mind-Body Interventions for Rehabilitation Medicine: Promoting Wellness, Healing, and Coping with Adversity. Phys Med Rehabil Clin N Am 2020; 31:563-575. [PMID: 32981579 DOI: 10.1016/j.pmr.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physical medicine providers work to cure organic aspects of disease while simultaneously enhancing quality of life and well-being. Mind-body interventions are evidence-based, cost-effective approaches to serve these aims. This article enhances provider knowledge and acceptance of the most effective and prevalent mind-body modalities: meditation, guided imagery, clinical hypnosis, and biofeedback. The scientific evidence is strongest for mind-body applications for chronic pain, primary headache, cardiac rehabilitation, and cancer rehabilitation, with preliminary evidence for traumatic brain injury and cerebrovascular events. Mind-body interventions are well-tolerated by patients and should be considered part of standard care in physical medicine and rehabilitation settings.
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Affiliation(s)
- Jessica Pieczynski
- Greater Los Angeles VA Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA.
| | - David Cosio
- Jesse Brown VA Medical Center, 820 South Damen Avenue, Chicago, IL 60612, USA
| | - Whitney Pierce
- VA St. Louis Healthcare System, 915 North Grand Boulevard, St Louis, MO 63106, USA
| | - J Greg Serpa
- Greater Los Angeles VA Healthcare System, UCLA Department of Psychology, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
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Monteiro J, Tanday A, Ashley PF, Parekh S, Alamri H. Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment. Cochrane Database Syst Rev 2020; 2:CD011024. [PMID: 32104910 PMCID: PMC7045283 DOI: 10.1002/14651858.cd011024.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Delivery of pain-free dentistry is crucial for reducing fear and anxiety, completion of treatment, and increasing acceptance of future dental treatment in children. Local anaesthetic (LA) facilitates this pain-free approach but it remains challenging. A number of interventions to help children cope with delivery of LA have been described, with no consensus on the best method to increase its acceptance. OBJECTIVES To evaluate the effects of methods for acceptance of LA in children and adolescents during dental treatment. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health's Trials Register (to 24 May 2019); the Cochrane Central Register of Controlled Trials (CENTRAL; 2019 Issue 4) in the Cochrane Library (searched 24 May 2019); MEDLINE Ovid (1946 to 24 of May 2019); Embase Ovid (1980 to 24 May 2019); and Web of Science (1900 to 24 May 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were also searched to 24 May 2019. There were no restrictions on language or date of publications. SELECTION CRITERIA Parallel randomised controlled trials (RCTs) of interventions used to increase acceptance of dental LA in children and adolescents under the age of 18 years. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We performed data extraction and assessment of risk of bias independently and in duplicate. We contacted authors for missing information. We assessed the certainty of the body of evidence using GRADE. MAIN RESULTS We included 26 trials with 2435 randomised participants aged between 2 and 16 years. Studies were carried out between 2002 and 2019 in dental clinics in the UK, USA, the Netherlands, Iran, India, France, Egypt, Saudi Arabia, Syria, Mexico, and Korea. Studies included equipment interventions (using several LA delivery devices for injection or audiovisual aids used immediately prior to or during LA delivery or both) and dentist interventions (psychological behaviour interventions delivered in advance of LA (video modelling), or immediately prior to or during delivery of LA or both (hypnosis, counter-stimulation). We judged one study to be at low risk and the rest at high risk of bias. Clinical heterogeneity of the included studies rendered it impossible to pool data into meta-analyses. None of the studies reported on our primary outcome of acceptance of LA. No studies reported on the following secondary outcomes: completion of dental treatment, successful LA/painless treatment, patient satisfaction, parent satisfaction, and adverse events. Audiovisual distraction compared to conventional treatment: the evidence was uncertain for the outcome pain-related behaviour during delivery of LA with a reduction in negative behaviour when 3D video glasses where used in the audiovisual distraction group (risk ratio (RR) 0.13, 95% confidence interval (CI) 0.03 to 0.50; 1 trial, 60 participants; very low-certainty evidence). The wand versus conventional treatment: the evidence was uncertain regarding the effect of the wand on pain-related behaviour during delivery of LA. Four studies reported a benefit in using the wand while the remaining studies results suggested no difference between the two methods of delivering LA (six trials, 704 participants; very low-certainty evidence). Counter-stimulation/distraction versus conventional treatment: the evidence was uncertain for the outcome pain experience during delivery of LA with children experiencing less pain when counter-stimulation was used (RR 0.12, 95% CI 0.04 to 0.34; 1 trial, 134 participants; very low-certainty evidence). Hypnosis versus conventional treatment: the evidence was uncertain for the outcome pain experience during delivery of LA with participants in the hypnosis group experiencing less pain (mean difference (MD) -1.79, 95% CI -3.01 to -0.57; 1 trial, 29 participants; very low-certainty evidence). Other comparisons considered included pre-cooling of the injection site, the wand versus Sleeper One, the use of a camouflage syringe, use of an electrical counter-stimulation device, and video modelling acclimatisation, and had a single study each. The findings from these other comparisons were insufficient to draw any affirmative conclusions about their effectiveness, and were considered to be very low-certainty evidence. AUTHORS' CONCLUSIONS We did not find sufficient evidence to draw firm conclusions as to the best interventions to increase acceptance of LA in children due to variation in methodology and nature/timing of outcome measures. We recommend further parallel RCTs, reported in line with the CONSORT Statement. Care should be taken when choosing outcome measures.
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Affiliation(s)
- Joana Monteiro
- UCL Eastman Dental InstituteUnit of Paediatric Dentistry, Department of Craniofacial Growth and Development256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Ajit Tanday
- UCL Eastman Dental InstituteUnit of Paediatric Dentistry, Department of Craniofacial Growth and Development256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Paul F Ashley
- UCL Eastman Dental InstituteUnit of Paediatric Dentistry, Department of Craniofacial Growth and Development256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Susan Parekh
- UCL Eastman Dental InstituteUnit of Paediatric Dentistry, Department of Craniofacial Growth and Development256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Hamdan Alamri
- The University of ManchesterPhD student at School of Medical Sciences, Division of DentistryManchesterUK
- College of Dentistry, Majmaah UniversityDepartment of Preventive DentistryAl Majma'ahSaudi Arabia
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Coté CJ, Wilson S. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures. Pediatrics 2019; 143:peds.2019-1000. [PMID: 31138666 DOI: 10.1542/peds.2019-1000] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of appropriately trained staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.
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Dilmahomed H, Jovani-Sancho M. Hypnoanalgesia in Dentistry: A Literature Review. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2019; 61:258-275. [PMID: 34874236 DOI: 10.1080/00029157.2017.1409613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this literature review is to evaluate the efficacy of hypnosis as a pain relieving method during and after dental procedures. Evaluation criteria considered include references focusing on pain that could encompass anxiety and physiological parameters. References focusing on pain that could include anxiety and physiological parameters as evaluation criteria were taken into consideration. From the 15 studies meeting inclusion criteria, it was found that when used as an individual therapy, hypnosis led to an increase in patient pain threshold. However, effectiveness was directly dependent on the degree of discomfort of the dental treatment performed, with low pain procedures having a higher success rate. When used as an adjunct to local anesthesia, hypnosis reduces postoperative analgesic consumption, eases general discomfort in patients, and decreases anxiety levels.
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Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2018; 10:CD005179. [PMID: 30284240 PMCID: PMC6517234 DOI: 10.1002/14651858.cd005179.pub4] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND This is the second update of a Cochrane Review (Issue 4, 2006). Pain and distress from needle-related procedures are common during childhood and can be reduced through use of psychological interventions (cognitive or behavioral strategies, or both). Our first review update (Issue 10, 2013) showed efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents. OBJECTIVES To assess the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents. SEARCH METHODS We searched six electronic databases for relevant trials: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; PsycINFO; Embase; Web of Science (ISI Web of Knowledge); and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We sent requests for additional studies to pediatric pain and child health electronic listservs. We also searched registries for relevant completed trials: clinicaltrials.gov; and World Health Organization International Clinical Trials Registry Platform (www.who.int.trialsearch). We conducted searches up to September 2017 to identify records published since the last review update in 2013. SELECTION CRITERIA We included peer-reviewed published randomized controlled trials (RCTs) with at least five participants per study arm, comparing a psychological intervention with a control or comparison group. Trials involved children aged two to 19 years undergoing any needle-related medical procedure. DATA COLLECTION AND ANALYSIS Two review authors extracted data and assessed risks of bias using the Cochrane 'Risk of bias' tool. We examined pain and distress assessed by child self-report, observer global report, and behavioral measurement (primary outcomes). We also examined any reported physiological outcomes and adverse events (secondary outcomes). We used meta-analysis to assess the efficacy of identified psychological interventions relative to a comparator (i.e. no treatment, other active treatment, treatment as usual, or waitlist) for each outcome separately. We used Review Manager 5 software to compute standardized mean differences (SMDs) with 95% confidence intervals (CIs), and GRADE to assess the quality of the evidence. MAIN RESULTS We included 59 trials (20 new for this update) with 5550 participants. Needle procedures primarily included venipuncture, intravenous insertion, and vaccine injections. Studies included children aged two to 19 years, with few trials focused on adolescents. The most common psychological interventions were distraction (n = 32), combined cognitive behavioral therapy (CBT; n = 18), and hypnosis (n = 8). Preparation/information (n = 4), breathing (n = 4), suggestion (n = 3), and memory alteration (n = 1) were also included. Control groups were often 'standard care', which varied across studies. Across all studies, 'Risk of bias' scores indicated several domains at high or unclear risk, most notably allocation concealment, blinding of participants and outcome assessment, and selective reporting. We downgraded the quality of evidence largely due to serious study limitations, inconsistency, and imprecision.Very low- to low-quality evidence supported the efficacy of distraction for self-reported pain (n = 30, 2802 participants; SMD -0.56, 95% CI -0.78 to -0.33) and distress (n = 4, 426 participants; SMD -0.82, 95% CI -1.45 to -0.18), observer-reported pain (n = 11, 1512 participants; SMD -0.62, 95% CI -1.00 to -0.23) and distress (n = 5, 1067 participants; SMD -0.72, 95% CI -1.41 to -0.03), and behavioral distress (n = 7, 500 participants; SMD -0.44, 95% CI -0.84 to -0.04). Distraction was not efficacious for behavioral pain (n = 4, 309 participants; SMD -0.33, 95% CI -0.69 to 0.03). Very low-quality evidence indicated hypnosis was efficacious for reducing self-reported pain (n = 5, 176 participants; SMD -1.40, 95% CI -2.32 to -0.48) and distress (n = 5, 176 participants; SMD -2.53, 95% CI -3.93 to -1.12), and behavioral distress (n = 6, 193 participants; SMD -1.15, 95% CI -1.76 to -0.53), but not behavioral pain (n = 2, 69 participants; SMD -0.38, 95% CI -1.57 to 0.81). No studies assessed hypnosis for observer-reported pain and only one study assessed observer-reported distress. Very low- to low-quality evidence supported the efficacy of combined CBT for observer-reported pain (n = 4, 385 participants; SMD -0.52, 95% CI -0.73 to -0.30) and behavioral distress (n = 11, 1105 participants; SMD -0.40, 95% CI -0.67 to -0.14), but not self-reported pain (n = 14, 1359 participants; SMD -0.27, 95% CI -0.58 to 0.03), self-reported distress (n = 6, 234 participants; SMD -0.26, 95% CI -0.56 to 0.04), observer-reported distress (n = 6, 765 participants; SMD 0.08, 95% CI -0.34 to 0.50), or behavioral pain (n = 2, 95 participants; SMD -0.65, 95% CI -2.36 to 1.06). Very low-quality evidence showed efficacy of breathing interventions for self-reported pain (n = 4, 298 participants; SMD -1.04, 95% CI -1.86 to -0.22), but there were too few studies for meta-analysis of other outcomes. Very low-quality evidence revealed no effect for preparation/information (n = 4, 313 participants) or suggestion (n = 3, 218 participants) for any pain or distress outcome. Given only a single trial, we could draw no conclusions about memory alteration. Adverse events of respiratory difficulties were only reported in one breathing intervention. AUTHORS' CONCLUSIONS We identified evidence supporting the efficacy of distraction, hypnosis, combined CBT, and breathing interventions for reducing children's needle-related pain or distress, or both. Support for the efficacy of combined CBT and breathing interventions is new from our last review update due to the availability of new evidence. The quality of trials and overall evidence remains low to very low, underscoring the need for improved methodological rigor and trial reporting. Despite low-quality evidence, the potential benefits of reduced pain or distress or both support the evidence in favor of using these interventions in clinical practice.
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Affiliation(s)
- Kathryn A Birnie
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Abstract
Although anxiety is the most common mental health condition among adolescents in the United States, the current standards of practice for treatment are expensive, may be difficult to obtain, and potentially harmful. Although mind and body practices show great promise in the treatment of adolescent anxiety, financial constraints, lack of education, and structural barriers can hinder the integration of these practices into primary care.
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Affiliation(s)
- Bernadette Fulweiler
- Bernadette Fulweiler is a pediatric NP at the Nemours Alfred I. DuPont Hospital for Children, Wilmington, Del. Rita Marie John is the director of the Pediatric Primary Care Nurse Practitioner Program at Columbia University School of Nursing, New York, NY
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Chiu L, Lee HW, Lam WK. THE EFFECTIVENESS OF HYPNOTHERAPY IN THE TREATMENT OF CHINESE PSYCHIATRIC PATIENTS. Int J Clin Exp Hypn 2018; 66:315-330. [PMID: 29856286 DOI: 10.1080/00207144.2018.1461472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This is a prospective randomized, controlled study of patients suffering from anxiety, depression, or mixed anxiety-depressive disorder attending a hypnotherapy clinic for 8 weeks. Participants were assessed with various clinical scales and randomly assigned to either the study or control group. The study group received 5 to 7 sessions of hypnotherapy through the 8-week period, whereas the control group received conventional psychiatric treatment. All patients' clinical conditions were reassessed at the end of the 8th week. Comparing study and control groups at the end of the 8th week, there was improvement in the study group in the scores of an array of clinical scales. Such satisfactory results illustrate the effectiveness of hypnotherapy in relieving anxiety and depressive symptoms.
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Affiliation(s)
- Ling Chiu
- a Kowloon Hospital , Hong Kong , China
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Halsband U, Wolf TG. Functional changes in brain activity after hypnosis in patients with dental phobia. ACTA ACUST UNITED AC 2016; 109:131-142. [PMID: 27720948 DOI: 10.1016/j.jphysparis.2016.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 02/07/2023]
Abstract
Visiting the dentist is often accompanied by apprehension or anxiety. People, who suffer from specific dental phobia (a disproportional fear of dental) procedures show psychological and physiological symptoms which make dental treatments difficult or impossible. For such purposes, hypnosis is often used in dental practice as an alternative for a number of treatments adjuvant or instead of sedation or general anaesthetics, as medication is often associated with risks and side effects. This is the first study to address the effects of a brief dental hypnosis on the fear processing structures of the brain in dental phobics using functional magnetic resonance imaging (fMRI). 12 dental phobics (DP; mean 34.9years) and 12 healthy controls (CO; mean 33.2years) were scanned with a 3T MRI whole body-scanner observing brain activity changes after a brief hypnotic invervention. An fMRI event-related design symptom provocation task applying animated audio-visual pseudorandomized strong phobic stimuli was presented in order to maximize the fearful reactions during scanning. Control videos showed the use of familiar electronic household equipment. In DP group, main effects of fear condition were found in the left amygdala and bilaterally in the anterior cingulate cortex (ACC), insula and hippocampu (R<L). During hypnosis DP showed a significantly reduced activation in all of these areas. Reduced neural activity patterns were also found in the control group. No amygdala activation was detected in healthy subjects in the two experimental conditions. Compared to DP, CO showed less bilateral activation in the insula and ACC in the awake condition. Findings show that anxiety-provoking stimuli such as undergoing dental surgery, endodontic treatments or insufficient anaesthetics, can be effectively reduced under hypnosis. The present study gives scientific evidence that hypnosis is a powerful and successful method for inhibiting the reaction of the fear circuitry structures.
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Affiliation(s)
- Ulrike Halsband
- Department of Psychology, Neuropsychology, University of Freiburg, Germany.
| | - Thomas Gerhard Wolf
- Department of Operative Dentistry, University Medical Center, University of Mainz, Germany
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Coté CJ, Wilson S. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016. Pediatrics 2016; 138:peds.2016-1212. [PMID: 27354454 DOI: 10.1542/peds.2016-1212] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.
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Corman I, Bouchema Y, Miquel B, Rousseau H, Bouvier D, Voilmy N, Beauvais F, Cohen-Solal A, Vicaut E, Logeart D, Tournoux F. HypnosIS to faciLitate trans-Esophageal echocardiograPhy Tolerance: The I-SLEPT study. Arch Cardiovasc Dis 2016; 109:171-7. [DOI: 10.1016/j.acvd.2015.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
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Wolf TG, Wolf D, Below D, d'Hoedt B, Willershausen B, Daubländer M. Effectiveness of Self-Hypnosis on the Relief of Experimental Dental Pain: A Randomized Trial. Int J Clin Exp Hypn 2016; 64:187-99. [PMID: 26894422 DOI: 10.1080/00207144.2016.1131587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This randomized, controlled clinical trial evaluates the effectiveness of self-hypnosis on pain perception. Pain thresholds were measured, and a targeted, standardized pain stimulus was created by electrical stimulation of the dental pulp of an upper anterior tooth. Pain stimulus was rated by a visual analogue scale (VAS). The pain threshold under self-hypnosis was higher (57.1 ± 17.1) than without hypnotic intervention (39.5 ± 11.8) (p < .001). Pain was rated lower on the VAS with self-hypnosis (4.0 ± 3.8) than in the basal condition without self-hypnosis (7.1 ± 2.7) (p < .001). Self-hypnosis can be used in clinical practice as an adjunct to the gold standard of local anesthesia for pain management, as well as an alternative in individual cases.
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Affiliation(s)
- Thomas Gerhard Wolf
- a University Medical Center of the Johannes Gutenberg University Mainz , Germany
| | - Dominik Wolf
- a University Medical Center of the Johannes Gutenberg University Mainz , Germany
| | - Dagna Below
- a University Medical Center of the Johannes Gutenberg University Mainz , Germany
| | - Bernd d'Hoedt
- a University Medical Center of the Johannes Gutenberg University Mainz , Germany
| | - Brita Willershausen
- a University Medical Center of the Johannes Gutenberg University Mainz , Germany
| | - Monika Daubländer
- a University Medical Center of the Johannes Gutenberg University Mainz , Germany
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Clinical Issues—December 2015. AORN J 2015. [DOI: 10.1016/j.aorn.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Glaesmer H, Geupel H, Haak R. A controlled trial on the effect of hypnosis on dental anxiety in tooth removal patients. PATIENT EDUCATION AND COUNSELING 2015; 98:1112-1115. [PMID: 26054452 DOI: 10.1016/j.pec.2015.05.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/27/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Empirical evidence concerning the efficacy of hypnosis to reduce anxiety in dental patients is limited. Hence we conducted a controlled trial in patients undergoing tooth removal. The study aims at assessing patient's attitude toward hypnosis and comparing the course of dental anxiety before, during and subsequent to tooth removal in patients with treatment as usual (TAU) and patients with treatment as usual and hypnosis (TAU+HYP). METHODS 102 patients in a dental practice were assigned to TAU or TAU+HYP. Dental anxiety was assessed before, during and after treatment. All patients were asked about their experiences and attitudes toward hypnosis. RESULTS More than 90% of patients had positive attitudes toward hypnosis. Dental anxiety was highest before treatment, and was decreasing across the three assessment points in both groups. The TAU+HYP group reported significantly lower levels of anxiety during treatment, but not after treatment compared with TAU group. CONCLUSION Our findings confirm that hypnosis is beneficial as an adjunct intervention to reduce anxiety in patients undergoing tooth removal, particularly with regard to its no-invasive nature. PRACTICAL IMPLICATION The findings underline that hypnosis is not only beneficial, but also highly accepted by the patients. Implementation of hypnosis in routine dental care should be forwarded.
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Affiliation(s)
- Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany.
| | | | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Germany
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Manyande A, Cyna AM, Yip P, Chooi C, Middleton P. Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database Syst Rev 2015; 2015:CD006447. [PMID: 26171895 PMCID: PMC8935979 DOI: 10.1002/14651858.cd006447.pub3] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Induction of general anaesthesia can be distressing for children. Non-pharmacological methods for reducing anxiety and improving co-operation may avoid the adverse effects of preoperative sedation. OBJECTIVES To assess the effects of non-pharmacological interventions in assisting induction of anaesthesia in children by reducing their anxiety, distress or increasing their co-operation. SEARCH METHODS In this updated review we searched CENTRAL (the Cochrane Library 2012, Issue 12) and searched the following databases from inception to 15 January 2013: MEDLINE, EMBASE, PsycINFO and Web of Science. We reran the search in August 2014. We will deal with the single study found to be of interest when we next update the review. SELECTION CRITERIA We included randomized controlled trials of a non-pharmacological intervention implemented on the day of surgery or anaesthesia. DATA COLLECTION AND ANALYSIS At least two review authors independently extracted data and assessed risk of bias in trials. MAIN RESULTS We included 28 trials (2681 children) investigating 17 interventions of interest; all trials were conducted in high-income countries. Overall we judged the trials to be at high risk of bias. Except for parental acupuncture (graded low), all other GRADE assessments of the primary outcomes of comparisons were very low, indicating a high degree of uncertainty about the overall findings. Parental presence: In five trials (557 children), parental presence at induction of anaesthesia did not reduce child anxiety compared with not having a parent present (standardized mean difference (SMD) 0.03, 95% confidence interval (CI) -0.14 to 0.20). In a further three trials (267 children) where we were unable to pool results, we found no clear differences in child anxiety, whether a parent was present or not. In a single trial, child anxiety showed no significant difference whether one or two parents were present, although parental anxiety was significantly reduced when both parents were present at the induction. Parental presence was significantly less effective than sedative premedication in reducing children's anxiety at induction in three trials with 254 children (we could not pool results). Child interventions (passive): When a video of the child's choice was played during induction, children were significantly less anxious than controls (median difference modified Yale Preoperative Anxiety Scale (mYPAS) 31.2, 95% CI 27.1 to 33.3) in a trial of 91 children. In another trial of 120 children, co-operation at induction did not differ significantly when a video fairytale was played before induction. Children exposed to low sensory stimulation were significantly less anxious than control children on introduction of the anaesthesia mask and more likely to be co-operative during induction in one trial of 70 children. Music therapy did not show a significant effect on children's anxiety in another trial of 51 children. Child interventions (mask introduction): We found no significant differences between a mask exposure intervention and control in a single trial of 103 children for child anxiety (risk ratio (RR) 0.59, 95% CI 0.31 to 1.11) although children did demonstrate significantly better co-operation in the mask exposure group (RR 1.27, 95% CI 1.06 to 1.51). Child interventions (interactive): In a three-arm trial of 168 children, preparation with interactive computer packages (in addition to parental presence) was more effective than verbal preparation, although differences between computer and cartoon preparation were not significant, and neither was cartoon preparation when compared with verbal preparation. Children given video games before induction were significantly less anxious at induction than those in the control group (mYPAS mean difference (MD) -9.80, 95% CI -19.42 to -0.18) and also when compared with children who were sedated with midazolam (mYPAS MD -12.20, 95% CI -21.82 to -2.58) in a trial of 112 children. When compared with parental presence only, clowns or clown doctors significantly lessened children's anxiety in the operating/induction room (mYPAS MD -24.41, 95% CI -38.43 to -10.48; random-effects, I² 75%) in three trials with a total of 133 children. However, we saw no significant differences in child anxiety in the operating room between clowns/clown doctors and sedative premedication (mYPAS MD -9.67, 95% CI -21.14 to 1.80, random-effects, I² 66%; 2 trials of 93 children). In a trial of hypnotherapy versus sedative premedication in 50 children, there were no significant differences in children's anxiety at induction (RR 0.59, 95% CI 0.33 to 1.04). Parental interventions: Children of parents having acupuncture compared with parental sham acupuncture were less anxious during induction (mYPAS MD -17, 95% CI -30.51 to -3.49) and were more co-operative (RR 1.59, 95% CI 1.01 to 2.53) in a single trial of 67 children. Two trials with 191 parents assessed the effects of parental video viewing but did not report any of the review's prespecified primary outcomes. AUTHORS' CONCLUSIONS This review shows that the presence of parents during induction of general anaesthesia does not diminish their child's anxiety. Potentially promising non-pharmacological interventions such as parental acupuncture; clowns/clown doctors; playing videos of the child's choice during induction; low sensory stimulation; and hand-held video games need further investigation in larger studies.
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Affiliation(s)
- Anne Manyande
- University of West LondonSchool of Psychology, Social Work and Human SciencesBoston Manor RoadBrentfordLondonUKTW8 9GA
| | - Allan M Cyna
- Women's and Children's HospitalDepartment of Women's Anaesthesia72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Peggy Yip
- Starship Children's HospitalDepartment of Paediatric AnaesthesiaAucklandNew Zealand
| | - Cheryl Chooi
- Women's and Children's HospitalDepartment of Women's Anaesthesia72 King William RoadAdelaideSouth AustraliaAustralia5006
- The University of AdelaideDepartment of Acute Care MedicineAdelaideAustralia
| | - Philippa Middleton
- The University of AdelaideWomen's and Children's Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
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Jenkins BN, Fortier MA, Kaplan SH, Mayes LC, Kain ZN. Development of a short version of the modified Yale Preoperative Anxiety Scale. Anesth Analg 2014; 119:643-650. [PMID: 25010821 DOI: 10.1213/ane.0000000000000350] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The modified Yale Preoperative Anxiety Scale (mYPAS) is the current "criterion standard" for assessing child anxiety during induction of anesthesia and has been used in >100 studies. This observational instrument covers 5 items and is typically administered at 4 perioperative time points. Application of this complex instrument in busy operating room (OR) settings, however, presents a challenge. In this investigation, we examined whether the instrument could be modified and made easier to use in OR settings. METHODS This study used qualitative methods, principal component analyses, Cronbach αs, and effect sizes to create the mYPAS-Short Form (mYPAS-SF) and reduce time points of assessment. Data were obtained from multiple patients (N = 3798; Mage = 5.63) who were recruited in previous investigations using the mYPAS over the past 15 years. RESULTS After qualitative analysis, the "use of parent" item was eliminated due to content overlap with other items. The reduced item set accounted for 82% or more of the variance in child anxiety and produced the Cronbach α of at least 0.92. To reduce the number of time points of assessment, a minimum Cohen d effect size criterion of 0.48 change in mYPAS score across time points was used. This led to eliminating the walk to the OR and entrance to the OR time points. CONCLUSIONS Reducing the mYPAS to 4 items, creating the mYPAS-SF that can be administered at 2 time points, retained the accuracy of the measure while allowing the instrument to be more easily used in clinical research settings.
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Affiliation(s)
- Brooke N Jenkins
- From the Department of Anesthesiology & Perioperative Care, †Department of Psychology and Social Behavior, ‡Health Policy Research Institute, and §Department of Medicine, University of California, Irvine, Irvine, California; and ‖Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
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Birnie KA, Noel M, Parker JA, Chambers CT, Uman LS, Kisely SR, McGrath PJ. Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents. J Pediatr Psychol 2014. [PMID: 24891439 DOI: 10.1093/jpepsy/jsu029.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To systematically review the evidence (and quality) for distraction and hypnosis for needle-related pain and distress in children and adolescents. To explore the effects of distraction characteristics (e.g., adult involvement, type of distracter), child age, and study risk of bias on treatment efficacy. METHODS 26 distraction and 7 hypnosis trials were included and self-report, observer-report, and behavioral pain intensity and distress examined. Distraction studies were coded for 4 intervention characteristics, and all studies coded for child age and study risk of bias. RESULTS Findings showed strong support for distraction and hypnosis for reducing pain and distress from needle procedures. The quality of available evidence was low, however. Characteristics of distraction interventions, child age, and study risk of bias showed some influence on treatment efficacy. CONCLUSIONS Distraction and hypnosis are efficacious in reducing needle-related pain and distress in children. The quality of trials in this area needs to be improved.
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Affiliation(s)
- Kathryn A Birnie
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Melanie Noel
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Jennifer A Parker
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Lindsay S Uman
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Steve R Kisely
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Patrick J McGrath
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
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Birnie KA, Noel M, Parker JA, Chambers CT, Uman LS, Kisely SR, McGrath PJ. Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents. J Pediatr Psychol 2014; 39:783-808. [PMID: 24891439 DOI: 10.1093/jpepsy/jsu029] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To systematically review the evidence (and quality) for distraction and hypnosis for needle-related pain and distress in children and adolescents. To explore the effects of distraction characteristics (e.g., adult involvement, type of distracter), child age, and study risk of bias on treatment efficacy. METHODS 26 distraction and 7 hypnosis trials were included and self-report, observer-report, and behavioral pain intensity and distress examined. Distraction studies were coded for 4 intervention characteristics, and all studies coded for child age and study risk of bias. RESULTS Findings showed strong support for distraction and hypnosis for reducing pain and distress from needle procedures. The quality of available evidence was low, however. Characteristics of distraction interventions, child age, and study risk of bias showed some influence on treatment efficacy. CONCLUSIONS Distraction and hypnosis are efficacious in reducing needle-related pain and distress in children. The quality of trials in this area needs to be improved.
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Affiliation(s)
- Kathryn A Birnie
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Melanie Noel
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Jennifer A Parker
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Lindsay S Uman
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Steve R Kisely
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
| | - Patrick J McGrath
- Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland Department of Psychology and Neuroscience, Dalhousie University, Centre for Pediatric Pain Research, IWK Health Centre, Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Pediatrics, Dalhousie University, Mental Health and Addiction Services, IWK Health Centre, and School of Population Health, The University of Queensland
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Monteiro J, Tanday A, Ashley PF, Parekh S, Petrie A. Interventions for increasing acceptance of local anaesthetic in children having dental treatment. Hippokratia 2014. [DOI: 10.1002/14651858.cd011024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Joana Monteiro
- UCL Eastman Dental Institute; Paediatric Dentistry; 256 Gray's Inn Road London UK WC1X 8LD
| | - Ajit Tanday
- UCL Eastman Dental Institute; Paediatric Dentistry; 256 Gray's Inn Road London UK WC1X 8LD
| | - Paul F Ashley
- UCL Eastman Dental Institute; Paediatric Dentistry; 256 Gray's Inn Road London UK WC1X 8LD
| | - Susan Parekh
- UCL Eastman Dental Institute; Paediatric Dentistry; 256 Gray's Inn Road London UK WC1X 8LD
| | - Aviva Petrie
- UCL Eastman Dental Institute; Biostatistics Unit; 256 Gray's Inn Road London UK WC1X 8LD
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Uman LS, Birnie KA, Noel M, Parker JA, Chambers CT, McGrath PJ, Kisely SR. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2013:CD005179. [PMID: 24108531 DOI: 10.1002/14651858.cd005179.pub3] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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 a number of psychological interventions were efficacious in managing pediatric needle pain, including distraction, hypnosis, and combined cognitive behavioural interventions. Considerable additional research in the area has been published since that time. OBJECTIVES To provide an update to our 2006 review assessing the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents. SEARCH METHODS 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. We ran an updated search in March 2012, and again in March 2013. SELECTION CRITERIA Participants included children and adolescents aged two to 19 years undergoing needle-related procedures. Only RCTs with at least five participants in each study arm comparing a psychological intervention group with a control or comparison group were eligible for inclusion. DATA COLLECTION AND 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% confidence intervals were computed for all analyses using Review Manager 5.2 software. MAIN RESULTS Thirty-nine trials with 3394 participants were included. The most commonly studied needle procedures were venipuncture, intravenous (IV) line insertion, and immunization. Studies included children aged two to 19 years, with the most evidence available for children under 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 (at least two or more 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, as evidence was available from single studies only. In addition, the Risk of bias scores indicated several domains with high or unclear bias scores (for example, selection, detection, and performance bias) suggesting that the methodological rigour and reporting of RCTs of psychological interventions continue to have considerable room for improvement. AUTHORS' 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 (that is, 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.
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Affiliation(s)
- Lindsay S Uman
- IWK Health Centre & Dalhousie University, Halifax, Nova Scotia, Canada
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Abdeshahi SK, Hashemipour MA, Mesgarzadeh V, Shahidi Payam A, Halaj Monfared A. Effect of hypnosis on induction of local anaesthesia, pain perception, control of haemorrhage and anxiety during extraction of third molars: A case–control study. J Craniomaxillofac Surg 2013; 41:310-5. [DOI: 10.1016/j.jcms.2012.10.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 11/16/2022] Open
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Effets de l’hypnose lors des soins dentaires. Presse Med 2013; 42:e114-24. [DOI: 10.1016/j.lpm.2012.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 07/11/2012] [Accepted: 08/27/2012] [Indexed: 11/20/2022] Open
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Picard P, Jusseaume C, Boutet M, Dualé C, Mulliez A, Aublet-Cuvellier B. Hypnosis for management of fibromyalgia. Int J Clin Exp Hypn 2013; 61:111-23. [PMID: 23153388 DOI: 10.1080/00207144.2013.729441] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This randomized, controlled trial contrasted the effects of 5 not-standardized sessions of hypnosis over 2 months in 59 women with fibromyalgia who were randomly assigned to treatment (n = 30) or a wait-list control group (n = 29). Patients in the treated group were encouraged to practice self-hypnosis. Fibromyalgia Impact Questionnaire (FIQ), MOS-Sleep Scale, Multidimensional Fatigue Inventory (MFI), Cognitive Strategy Questionnaire (CSQ), and Patient Global Impression of Change (PGIC) were administered at baseline, 3 months (M3), and 6 months (M6) after inclusion. Compared to the control, the hypnosis group reported better improvement on PGIC (p = .001 at M3, p = .01 at M6) and a significant improvement in sleep and CSQ dramatization subscale (both at M6).
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Pan F, Pan L, Zhang A, Liu Y, Zhang F, Dai Y. Circumcision with a novel disposable device in Chinese children: a randomized controlled trial. Int J Urol 2012; 20:220-6. [PMID: 22974480 DOI: 10.1111/j.1442-2042.2012.03132.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 07/26/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the outcomes and complications of three methods of circumcision in a Chinese pediatric population. METHODS A total of 120 children were randomly assigned to three groups. Group I was submitted to circumcision using the Shenghuan disposable device according to Yan's method; group II was submitted to circumcision using the same device, but according to Peng's methods; group III was operated on by using the conventional scalpel/suture technique. The three groups were compared mainly by the following outcomes: duration of surgery, intraoperative bleeding, postoperative pain, cosmetic effect, and the rates of edema, dehiscence, scarring, adhesion and infection. RESULTS Groups I and II had less intraoperative bleeding. In terms of the duration of surgery, group I was the quickest. Pain scores in using the Shenghuan disposable device were higher at 6 h after surgery compared with the conventional scalpel/suture technique. The percentage of patients using paracetamol in group II was higher than that in group III at 12 h after surgery. Other complications were similar, and all three groups had successful outcomes. CONCLUSIONS Circumcision using the Shenghuan disposable device represents a safer and time-saving option compared with the conventional scalpel/suture technique, with better cosmetic outcomes. Yan's method seems to be better than Peng's method when using the Shenghuan disposable device for circumcision in children.
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Affiliation(s)
- Feng Pan
- Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, School of Medicine, Nanjing, China
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Tomé-Pires C, Miró J. Hypnosis for the management of chronic and cancer procedure-related pain in children. Int J Clin Exp Hypn 2012; 60:432-57. [PMID: 22917107 DOI: 10.1080/00207144.2012.701092] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aim of this study was to review published controlled trials of hypnotic treatments for chronic and cancer procedure-related pain in children. Trials were included if participants were 18 years of age or below, were randomized and had populations with chronic pain or cancer procedure-related pain. After the studies were assessed, 12 were selected for review. Although the evidence is limited, the findings indicate that hypnosis is an effective pain-control technique when used with children suffering from cancer procedure-related pain or chronic pain. Further research into the use of hypnosis to manage chronic pain in children should be a priority so that empirically based conclusions can be drawn about the effects of hypnosis on children.
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Affiliation(s)
- Catarina Tomé-Pires
- Unit for the Study and Treatment of Pain-ALGOS, Centre de Recerca en Avaluació i Mesura de la Conducta, and Institut d'Investigació Universitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
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