Methodological Approaches to Pain Memory Assessment in Chronic Pain: A Scoping Review

Background/Objectives: Pain memory refers to the ability to encode, store, and recall information related to a specific pain event. Reviewing its common features is crucial, as it provides researchers with a foundational guide for designing studies that assess pain memory in individuals with chronic pain. The primary objective of this study was to examine the common characteristics-particularly the methodological approaches-of existing research on pain memory in adults with chronic pain. Methods: A scoping review was conducted using PubMed and Embase as search databases. Studies were included if they met the following criteria. (a) It involved only adults with chronic pain and (b) assessed at least one of the following parameters: pain intensity or pain unpleasantness. The exclusion criteria were the following: (a) not having pain memory assessment as a primary objective, (b) including participants under 18 years of age, (c) involving individuals without chronic pain (e.g., those with acute pain or healthy participants), (d) lacking essential information, or (e) unavailability of the full text. Results: From an initial pool of 4585 papers, 11 studies met the inclusion criteria. All studies exclusively involved adults with chronic pain, and all reported pain intensity, while only 27% assessed pain unpleasantness. Additionally, psychosocial variables were the most frequently reported non-pain-related outcomes. Regarding study protocols, most relied on daily data collection, with the most common recall period being within the first 48 h. Conclusions: The methodological characteristics identified in this review-particularly those with a high frequency of occurrence-should serve as fundamental guidelines for future research on pain memory in adults with chronic pain, and should be carefully considered by investigators in this field.

The effect of retrieval-induced forgetting for pain-related memories on child pain-related outcomes: A randomized experimental study

BACKGROUND

Children's inability to forget the negative aspects of a painful event is associated with more anticipatory anxiety at an upcoming pain task and lower pain thresholds; however, the impact of forgetting on children's pain outcomes has not been examined. Retrieval-Induced Forgetting (RIF) was experimentally induced to investigate whether children would (1) forget more negative details of a previous painful autobiographic event and; (2) report better pain-related outcomes for an unrelated pain task (i.e., cold pressor task; CPT). Additionally, it was investigated whether the success of RIF was dependent on child characteristics known to influence children's memories for pain (i.e., attention bias to pain, attention switching ability and pain catastrophizing).

METHODS

Healthy school children (N = 128; 9-16 years old) recalled and rehearsed memory details of two painful autobiographical events, while only children in the randomized RIF group rehearsed positive details. All children underwent two CPTs (before and after RIF) and reported pain-related outcomes. Two weeks later, children recalled CPT pain and reported on future pain expectancies.

RESULTS

Children in the RIF group remembered less negative details of their past autobiographical pain events, but also reported a greater reduction in pain-related fear from the CPT 2 compared to their ratings for CPT 1, than children in the control group. They furthermore expected less pain-related fear 2 weeks later for a future pain task.

DISCUSSION

Findings suggest that RIF is a promising avenue in pediatric pain management that could be harnessed to foster more positive memories and better future pain experiences.

SIGNIFICANCE STATEMENT

Retrieval-induced forgetting (RIF) makes children forget negative details of a past autobiographical pain experience, decreases experienced pain-related fear for experimental pain and lowers future pain-related fear expectancies. Results show a promising role for RIF- based memory interventions in the context of paediatric pain care.

A Randomized Controlled Trial of a Parent-Led Memory-Reframing Intervention to Reduce Distress and Pain Associated with Vaccine Injections in Young Children

Children remember their memories of pain long after the painful experience is over. Those memories predict higher levels of future pain intensity. Young children's memories can be reframed to be less distressing. Parents and the way they reminisce about past events with their children play a key role in the formation of pain memories. A novel parent-led memory-reframing intervention changed children's memories of post-surgical pain to be less distressing. The intervention efficacy in the context of vaccine injections is unclear. This registered randomized controlled trial (NCT05217563) aimed to fill this gap. Seventy-four children aged 4.49 years (SD = 1.05) and scheduled to obtain two COVID-19 vaccine injections and one of their parents were randomized to receive: (1) standard care; (2) standard care and memory-reframing information; and (3) standard care and memory-reframing information with verbal instructions. Children reported their pain after vaccine injections. One week after the first vaccination, children reported memory of pain. Parents reported their use of memory-reframing strategies and intervention feasibility and acceptability. The intervention did not result in significant differences in children's recalled or future pain. Parents rated the intervention as acceptable and feasible.

A scientometric and descriptive review on the debate about repressed memories and traumatic forgetting

Recent work suggests that the debate surrounding repressed memory and traumatic forgetting continues today. To further investigate this debate, we performed preregistered scientometric analyses on publications on the debate about repressed memory to provide information about its bibliometric evolution. Furthermore, we reviewed these publications to highlight the different positions taken by scholars on this debate. We reviewed 434 publications extracted from Scopus and Web of Science from 1969 to 2022. Our scientometric analyses permitted us to visualize the development of the publications on repressed memories and identify the terminology used to label this phenomenon. We identified three waves of publications (i.e., 1994-2000; 2003-2009; 2012-2021) showing that there is a recent peak of scholarly attention into this topic. 40% of scholars supported the phenomenon of repressed memory while 29% did not. Moreover, although in the last wave of publications, 35% of articles included critical arguments against the existence of repressed memory, a sizable number of publications (21%) supported ideas in favour of repressed memory. Finally, we observed that the term dissociative amnesia is another expression used to refer to the phenomenon. Our results provide additional evidence that the debate on repressed memories (and dissociative amnesia) is far from being over.

The Effect of Robot-Led Distraction during Needle Procedures on Pain-Related Memory Bias in Children with Chronic Diseases: A Pilot and Feasibility Study

The current study evaluated the feasibility and preliminary clinical impact of robot-led distraction during needle procedures in children with chronic diseases on pain-related memories. Participants were 22 children (8−12 years old) diagnosed with a chronic disease (e.g., chronic immune deficiency) and undergoing a needle procedure as part of their routine treatment. Children were randomized to the experimental group (i.e., robot-led distraction) or control group (i.e., usual care). For feasibility, we evaluated study- and needle-procedure-related characteristics, intervention fidelity and acceptability, and nurse perceptions of the intervention. Primary clinical outcomes included children’s memory bias for pain intensity and pain-related fear (1 week later). Results indicated that intervention components were >90% successful. Overall, the robot-led distraction intervention was perceived highly acceptable by the children, while nurse perceptions were mixed, indicating several challenges regarding the intervention. Preliminary between-group analyses indicated a medium effect size on memory bias for pain intensity (Hedges’ g = 0.70), but only a very small effect size on memory bias for pain-related fear (Hedges’ g = 0.09), in favor of the robot-led distraction intervention. To summarize, while feasible, certain challenges remain to clinically implement robot-led distraction during needle procedures. Further development of the intervention while accounting for individual child preferences is recommended.

A Memory-Reframing Intervention to Reduce Pain in Youth Undergoing Major Surgery: Pilot Randomized, Controlled Trial of Feasibility and Acceptability

Background

Three to 22% of youth undergoing surgery develop chronic postsurgical pain (CPSP). Negative biases in pain memories (i.e., recalling higher levels of pain as compared to initial reports) are a risk factor for CPSP development. Children’s memories for pain are modifiable. Existing memory-reframing interventions reduced negatively biased memories associated with procedural pain and pain after minor surgery. However, not one study has tested the feasibility and acceptability of the memory-reframing intervention in youth undergoing major surgery.

Aims

The current pilot randomized clinical trial (RCT; NCT03110367; clinicaltrials.gov) examined the feasibility and acceptability of, as well as adherence to, a memory reframing intervention.

Methods

Youth undergoing a major surgery reported their baseline and postsurgery pain levels. Four weeks postsurgery, youth and one of their parents were randomized to receive control or memory-reframing instructions. Following the instructions, parents and youth reminisced about the surgery either as they normally would (control) or using the memory-reframing strategies (intervention). Six weeks postsurgery, youth completed a pain memory interview; parents reported intervention acceptability. Four months postsurgery, youth reported their pain.

Results

Seventeen youth (76% girls, M_age = 14.1 years) completed the study. The intervention was feasible and acceptable. Parents, but not youth, adhered to the intervention principles. The effect sizes of the intervention on youth pain memories (η_p² = 0.22) and pain outcomes (η_p² = 0.23) were used to inform a larger RCT sample size.

Conclusions

Memory reframing is a promising avenue in pediatric pain research. Larger RCTs are needed to determine intervention efficacy to improve pain outcomes.

Lie for Me: Developmental Trends in Acquiescing to a Blatantly False Statement

A pair of studies demonstrates that simply asking children to make a blatantly false accusation in the guise of helping others can result in both immediate and long-term false claims. In the pilot study, the initial willingness to make a blatantly false statement was associated with some children making false statements a week later despite being told that the first interviewer had made mistakes during the initial interview. On a positive note, the majority of participants accurately stated that they did not have first-hand knowledge of their accusation's accuracy. Across both studies, the rate of false accusation rates was high. The main experiment demonstrated that children who were young, possessed the lowest verbal intelligence or who were from the lowest SES homes made the most accusations. These findings illustrate not only the dangers of encouraging children to make false statements, but the ease and durability of making such false statements.

Reframe the Pain: A Randomized Controlled Trial of a Parent-Led Memory-Reframing Intervention

Negatively-biased pain memories (ie, recalling more pain as compared to earlier reports) are a robust predictor of future pain experiences. This randomized controlled trial examined the efficacy of a memory-reframing intervention to reframe children's pain memories. Sixty-five children (54% girls, M_age=5.35 years) underwent a tonsillectomy and reported their levels of post-surgical pain intensity and pain-related fear. 2 weeks post-surgery, children and 1 of their parents were randomized to the memory-reframing intervention or control group. Following control/intervention instructions, parents and children reminisced about the past surgery as they normally would (control) or using the memory-reframing strategies (intervention). Children recalled their post-surgical pain intensity and pain-related fear one week later. Parents reported the intervention's acceptability. Recruitment statistics were used to assess feasibility. Controlling for initial pain intensity ratings and using the Faces Pain Scale Revised, children in the intervention group reported more accurate/positively-biased memories for day 1 post-surgery pain intensity (M = 2.60/10; 95% CI, 1.62 to 3.68), compared to children in the control group (M = 4.11/10; 95% CI, 3.12 to 5.03), η_p² = .07, p = .040. The intervention was acceptable and feasible. Optimal parent-child reminiscing about a past pain experience resulted in children remembering their pain more accurately/positively. Clinicaltrials.gov:NCT03538730. PERSPECTIVE: This article presents results of the first randomized controlled trial examining the efficacy of parent-led memory-reframing intervention to change children's memories for pain. Children of parents who were taught and engaged in optimal reminiscing about a past surgery experience remembered their pain intensity more accurately/positively.

The use and impact of repeated questions in diagnostic child abuse assessment interviews

There is limited research regarding the use of repeated questions and the subsequent response from children in real-world forensic contexts. We analysed 71 transcripts of diagnostic assessments in which 3- to 6-year-olds were assessed for suspected abuse experiences. On average, 6% of interviewer questions were repeated, and 47% of the repeated questions were abuse-related. The majority (65%) of the repeated questions were directive, but 33% of the repeated questions contained implicit assumptions. Implicit assumption questions were more likely to be abuse-related. Interviewers repeated questions when the child failed to answer due to playing (31%), for no apparent reason (26%) or for clarification purposes (29%). Children most commonly responded to repeat questions by providing new information (64%), not responding at all (19%) or repeating information (12%). We recommend that interviewers avoid the use of suggestive and repeated questions that contain implicit assumptions in relation to assessment of suspected child abuse.

Parent-Child Reminiscing about Past Pain as a Preparatory Technique in the Context of Children's Pain: A Narrative Review and Call for Future Research

Pain permeates childhood and remains inadequately and/or inconsistently managed. Existing research and clinical practice guidelines have largely focused on factors influencing the immediate experience of pain. The need for and benefits of preparing children for future pain (e.g., painful procedures) has been well established. Despite being a robust predictor of future pain and distress, memories of past painful experiences remain overlooked in pediatric pain management. Just as autobiographical memories prepare us for the future, children’s memories for past pain can be harnessed to prepare children for future painful experiences. Children’s pain memories are malleable and can be reframed to be less distressing, thus reducing anticipatory distress and promoting self-efficacy. Parents are powerful agents of change in the context of pediatric pain and valuable historians of children’s past painful experiences. They can alter children’s pain memories to be less distressing simply by talking, or reminiscing, about past pain. This narrative review summarizes existing research on parent–child reminiscing in the context of acute and chronic pediatric pain and argues for incorporation of parent–child reminiscing elements into preparatory interventions for painful procedures.

The role of narrative in the development of children's pain memories: influences of father- and mother-child reminiscing on children's recall of pain

Negatively biased memories for pain (ie, recalled pain is higher than initial report) robustly predict future pain experiences. During early childhood, parent-child reminiscing has been posited as playing a critical role in how children's memories are constructed and reconstructed; however, this has not been empirically demonstrated. This study examined the role of parent-child reminiscing about a recent painful surgery in young children's pain memory development. Participants included 112 children (Mage = 5.3 years; 60% boys) who underwent a tonsillectomy and one of their parents (34% fathers). Pain was assessed in hospital and during the recovery phase at home. Two weeks after surgery, parents and children attended a laboratory visit to participate in a structured narrative elicitation task wherein they reminisced about the surgery. Four weeks after surgery, children completed an established pain memory interview using the same previously administered scales through telephone. Narratives were coded for style (elaboration) and content (pain and emotion) based on coding schemes drawn from the developmental psychology literature. Findings revealed that a more elaborative parental reminiscing style in addition to greater use of emotional words predicted more accurate/positively biased pain memories. Greater parental use of pain words predicted more negatively biased pain memories. Although there were no sex and parent-role differences in pain memory biases, mothers and fathers differed in how they reminisced with their boys vs girls. This research underscores the importance of parent-child reminiscing in children's pain memory development and may be used to inform the development of a parent-led memory reframing intervention to improve pediatric pain management.

Misremembering pain: A memory blindness approach to adding a better end

How people remember feeling in the past informs future decisions; however, memory for past emotion is subject to a number of biases. Previous research on choice blindness has shown that people often fail to notice when they are exposed to misinformation about their own decisions, preferences, and memories. This type of misinformation can influence how they later remember past events. In the present study, we examined the memory blindness effect in a new domain: memory for pain. Participants (N = 269) underwent a cold-pressor task and rated how much pain, distress, and positive and negative affect they had experienced. Later, participants were shown their pain ratings and asked to explain them. Some of the participants were shown lower pain ratings than they had actually made. In a second session, participants recalled how painful the task had been and how much distress and positive and negative affect they remembered experiencing. The results indicated that the majority of participants who were exposed to misinformation failed to detect the manipulation, and subsequently remembered the task as being less painful. The participants in the misinformation condition were not overall more willing to repeat the study tasks, but the participants who recalled less distress, less negative affect, and more positive affect were more willing to repeat the study tasks again in a future experiment. These results demonstrate the malleability of memory for painful experiences and that willingness to repeat aversive experiences may depend more on memory for affective reactions to the original experience than on memory for the physical pain itself.

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

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.

Telling Stories

This paper analyses the rhetorical structure of psychological experiments investigating children's suggestibility, the wider context of debates that these inform, and the cultural-political status of psychological expertise that such claims bolster. It draws on the debates around childhood accounting to reverse the specular apparatus of the psychological gaze and so to inspect its practitioners according to those discourses and rhetorical devices by which it accounts for children. The stories psychologists tell about children are analysed as not only indicative of the contemporary legitimizing practices of the discipline, but also as suggesting a motivated forgetting or recasting of psychology's past approaches to the topics of children's beliefs, knowledge and memories. Thus, by turning the focus from the stories (we make) children tell, to our own storytelling practices as psychologists, this paper engages in a practice of critical relativism that opens the terms of developmental psychological inquiry up for critical scrutiny, and thereby both limits and secures the grounds for its claims.

HELPinKids&Adults Knowledge Synthesis of the Management of Vaccination Pain and High Levels of Needle Fear: Limitations of the Evidence and Recommendations for Future Research

The HELPinKids&Adults knowledge synthesis for the management of vaccination-related pain and high levels of needle fear updated and expanded upon the 2010 HELPinKIDS knowledge synthesis and clinical practice guideline for pain mitigation during vaccine injections in childhood. Interventions for vaccine pain management in adults and treatment of individuals with high levels of needle fear, phobias, or both were included, thereby broadening the reach of this work. The present paper outlines the overarching limitations of this diverse evidence base and provides recommendations for future research. Consistent with the framing of clinical questions in the systematic reviews, the Participants, Intervention, Comparison, Outcome, Study design (PICOAS) framework was used to organize these predominant issues and research directions. The major limitations we identified across systematic reviews were an overall dearth of trials on vaccination, lack of methodological rigor, failure to incorporate important outcomes, poor study reporting, and various sources of heterogeneity. Future research directions in terms of conducting additional trials in the vaccination context, improving methodological quality and rigor, assessment of global acceptability and feasibility of interventions, and inclusion of outcomes that stakeholders consider to be important (eg, compliance) are recommended. Given concerns about pain and fear are known contributors to vaccine hesitancy, improving and expanding this evidence base will be integral to broader efforts to improve vaccine compliance and public health worldwide.

Management of fear and anxiety in the dental clinic: a review

People who are highly anxious about undergoing dental treatment comprise approximately one in seven of the population and require careful and considerate management by dental practitioners. This paper presents a review of a number of non-pharmacological (behavioural and cognitive) techniques that can be used in the dental clinic or surgery in order to assist anxious individuals obtain needed dental care. Practical advice for managing anxious patients is provided and the evidence base for the various approaches is examined and summarized. The importance of firstly identifying dental fear and then understanding its aetiology, nature and associated components is stressed. Anxiety management techniques range from good communication and establishing rapport to the use of systematic desensitization and hypnosis. Some techniques require specialist training but many others could usefully be adopted for all dental patients, regardless of their known level of dental anxiety. It is concluded that successfully managing dentally fearful individuals is achievable for clinicians but requires a greater level of understanding, good communication and a phased treatment approach. There is an acceptable evidence base for several non-pharmacological anxiety management practices to help augment dental practitioners providing care to anxious or fearful children and adults.

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

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.

Expert testimony in a child sex abuse case: Translating memory development research

In this paper we describe a custody case that centred on allegations of child sexual abuse. A pair of preschool-aged sisters accused their biological father of various sexual acts, though their allegations were made under problematic conditions and were contradicted by other statements they made. In an affidavit written by one of us (MB), we describe the relevant memory development research in the course of presenting the court with a scientific analysis. We find compelling evidence of multiple risk factors in the way the daughters' recollections were elicited. Although the "ultimate question" of guilt is beyond our purview, our identification of risks was instrumental in the legal system's decision that the children's allegations were not valid. We put this analysis forward as an example of evidence-based testimony in which scientific findings from the memory literature can be used to frame an expert's analysis.

'I was just screeching!': comparing child and parent derived measures of distress

Two studies explored relationships between children's (2-13 years old) descriptions of how much they had cried and two other ways of assessing children's distress during injuries and subsequent hospital treatment, one parent-generated and the other child-generated. In the first study, 201 2- to 13-year-old children's descriptions of crying were compared with parental ratings of child distress, and in the second, these two measures plus a Faces Pain Scale were compared for 71 2- to 6-year-olds. Children's self-descriptions of crying were highly similar to parental ratings at all ages, but the Faces Pain Scale had less similarity to other measures, especially for younger preschoolers. Findings suggest that children's self-descriptions of emotional reactions may be a useful tool for assessing children's distress for real-world events with no adult witnesses.

Reliability of Children's Testimony in the Era of Developmental Reversals

A hoary assumption of the law is that children are more prone to false-memory reports than adults, and hence, their testimony is less reliable than adults'. Since the 1980s, that assumption has been buttressed by numerous studies that detected declines in false memory between early childhood and young adulthood under controlled conditions. Fuzzy-trace theory predicted reversals of this standard developmental pattern in circumstances that are directly relevant to testimony because they involve using the gist of experience to remember events. That prediction has been investigated during the past decade, and a large number of experiments have been published in which false memories have indeed been found to increase between early childhood and young adulthood. Further, experimentation has tied age increases in false memory to improvements in children's memory for semantic gist. According to current scientific evidence, the principle that children's testimony is necessarily more infected with false memories than adults' and that, other things being equal, juries should regard adult's testimony as necessarily more faithful to actual events is untenable.

Pain is not over when the needle ends: a review and preliminary model of acute pain memory development in childhood

SUMMARY Over the past several decades, the field of pediatric pain has made impressive advances in our understanding of the pain experience of the developing child, as well as the devastating impact of inadequately managed pain early in life. It is now well recognized that, from infancy, children are capable of developing implicit memories of pain that can influence their subsequent reactions to pain. The present review provides a synthesis of selected studies that made a significant impact on this field of inquiry, with particular emphasis on recent clinical and laboratory-based experimental research examining children’s explicit autobiographical memories for acute pain. Research has begun to move towards improving the precision with which children at risk for developing negatively estimated pain memories can be identified, given the adverse influence these memories can have on subsequent pain experiences. As such, several fear- and anxiety-related child and parent variables implicated in this process are discussed, and avenues for future research and clinical intervention are identified throughout. Finally, a preliminary empirically and theoretically derived model of acute pain memory development in childhood is presented to parsimoniously summarize the evidence accumulated to date and guide future investigation in this area.

Preschoolers' knowledge about hospital and emergency equipment and care

BACKGROUND

Information about preschoolers' understanding of hospital and emergency care and medical equipment is needed.

OBJECTIVE

The current study contributed to our understanding of young children's health literacy in these areas.

CONCLUSIONS

Findings indicated that preschool-age children had more accurate knowledge of an emergency care as opposed to a hospital scenario. Also, young children tended to recount their experiences when discussing what they knew, supporting the idea that they acquire schemas for this information. Parents tended to overestimate their children's knowledge. Children did not mention school as a place where they learned about hospital care and those health professionals working in school settings may be uniquely positioned to teach young children about hospital care. Children may absorb more information in this environment, and assessing whether this is true remains an area for future research.

Procedural pain management for children receiving physiotherapy

PURPOSE

This article provides an overview of literature relevant to the prevention and relief of pain and distress during physiotherapy procedures, with guidance for physiotherapists treating children.

SUMMARY OF KEY POINTS

Physiotherapists are generally well trained in assessing and managing pain as a symptom of injury or disease, but there is a need to improve the identification and management of pain produced by physiotherapy procedures such as stretching and splinting. In contrast to physiotherapy, other health care disciplines, such as dentistry, nursing, paediatrics, emergency medicine, and paediatric psychology, produce extensive literature on painful procedures. Procedural pain in children is particularly important because it can lead to later fear and avoidance of necessary medical care.

RECOMMENDATIONS

We emphasize the need for physiotherapists to recognize procedural pain and fear in the course of treatment using verbal, nonverbal, and contextual cues. We present many methods that physiotherapists can use to prevent or relieve procedural pain and fear in paediatric patients and provide an example of a simple, integrated plan for prevention and relief of distress induced by painful procedures.

The veridicality of children's reports of parenting: a review of factors contributing to parent-child discrepancies

Child informants routinely participate in forensic and social service investigations and are often a critical source of information. However, across research domains high levels of discrepancy between parents' reports and children's reports have been documented, which has led researchers to question children's abilities to provide accurate information about others' behavior. To date research examining parent-child discrepancies has focused on discrepancies in reports of child behavior. The aim of the present review is to examine children's abilities to provide veridical accounts of parental behaviors, drawing on developmental and clinical research to delineate factors likely to enhance or impede accuracy. Among the factors examined, age appears to have the strongest influence on the accuracy of children's reports in general. A clear distinction also emerged in the literature between children's abilities to report objective data versus information regarding abstract concepts. Although available evidence provides mixed support for the veridicality of children's reports of parenting, factors that influence children's accuracy have generally been overlooked. Namely, researchers have largely failed to discriminate between assessment of child-rearing behaviors and children's perceptions of those behaviors. The present review proposes that such failure likely accounts for a notable portion of parent-child discrepancies in reports of parenting.

Psychosocial correlates of medical mistrust among African American men

The current study proposed and tested a conceptual model of medical mistrust in a sample of African American men (N = 216) recruited primarily from barbershops in the Midwest and Southeast regions of the United States. Potential psychosocial correlates were grouped into background factors, masculine role identity/socialization factors, recent healthcare experiences, recent socioenvironmental experiences (e.g., discrimination), and healthcare system outcome expectations (e.g., perceived racism in healthcare). Direct and mediated relationships were assessed. Results from the hierarchical regression analyses suggest that perceived racism in healthcare was the most powerful correlate of medical mistrust even after controlling for other factors. Direct effects were found for age, masculine role identity, recent patient-physician interaction quality, and discrimination experiences. Also, perceived racism in healthcare mediated the relationship between discrimination experiences and medical mistrust. These findings suggest that African American men's mistrust of healthcare organizations is related to personal characteristics, previous negative social/healthcare experiences, and expectations of disparate treatment on the basis of race. These findings also imply that aspects of masculine role identity shape the tone of patient-physician interactions in ways that impede trust building processes.

Children's memory for painful procedures: the relationship of pain intensity, anxiety, and adult behaviors to subsequent recall

OBJECTIVE

To examine whether children's experience of pain intensity and anxiety, and adult behaviors during venepuncture, were related to children's memories of the procedure.

METHODS

Participants were 48 children (24 males, 24 females) between the ages of 5 and 10 years who underwent venepuncture. The venepunctures were videotaped and adult behaviors were coded. Children self-reported their pain intensity and anxiety immediately and 2 weeks following venepuncture and answered contextual questions at follow-up.

RESULTS

Children who initially reported higher levels of pain tended to over-estimate their anxiety at follow-up, whereas children who reported lower levels of pain accurately- or under-estimated their anxiety. Staff coping-promoting behaviors predicted the accuracy of children's contextual memories. Staff and parent behaviors did not predict children's recalled pain intensity and anxiety.

CONCLUSIONS

Results indicate that children's direct experience of pain intensity and staff behaviors during venepuncture are related to their memories. These data highlight the importance of effective pain management during medical procedures.

Socioemotional factors in child sexual abuse investigations

Two socioemotional factors were explored in association with children's production of forensic information during sexual abuse investigations: rapport building and interviewer's support. The study tested to what extent (a) the length and questioning style in the rapport-building session and (b) the level of support interviewers provided to the children, were associated with the amount of forensic details children provided in their investigation. These associations were explored for more talkative and less talkative children as well as for children of two age groups (4-6 and 7-9 years). A total of 71 forensic interviews of alleged victims of child sexual abuse were subject to a detailed psycholinguistic analysis. Results suggest that richer information in the child's responses is associated with a short and open style rapport-building session as well as with a higher level of interviewer's support. This association is especially marked for less talkative children who might be in special need of support and for whom the rapport with the interviewer might be more meaningful.

Truth induction in young maltreated children: the effects of oath-taking and reassurance on true and false disclosures

OBJECTIVE

Two studies examined the effects of the oath or reassurance ("truth induction") on 5- to 7-year-old maltreated children's true and false reports of a minor transgression.

METHODS

In both studies an interviewer elicited a promise to tell the truth, reassured children that they would not get in trouble for disclosing the transgression, or gave no instructions before questioning the child. In Study 1, children were encouraged to play with an attractive toy by a confederate, who then informed them that they might get in trouble for playing. In Study 2, a confederate engaged children in play, but did not play with the attractive toy.

RESULTS

In Study 1, the oath and reassurance increased disclosure among children who would qualify as competent to take the oath. In Study 2 neither the oath nor reassurance increased false reports among children who would qualify as competent, whether yes/no questions or tag questions were asked. Among non-competent children, reassurance (but not the oath) increased false reports. Children were more likely to accuse the confederate of the transgression than to implicate themselves.

CONCLUSIONS

The results suggest that a promise to tell the truth may increase true disclosures without increasing false allegations. Reassurance that specifically mentions the target activity also increases true disclosures, but may increase acquiescence among some children.

PRACTICE IMPLICATIONS

A child-friendly version of the oath may be a useful addition to child interviews.

Using memory restructuring strategy to enhance dental behaviour

AIMS

This study sought to 'restructure' memory of dental treatment to help children develop positive memories and cooperate more fully with the dentist at future visits.

DESIGN

The design compared 'usual care' plus an intervention designed to positively restructure memory with 'usual care' plus a control for 45 children, ages 6-9 years, who were in need of two restorative treatment visits. The intervention occurred at the second visit immediately before the dental treatment and focused on restructuring the child's memory of the first treatment visit. Children were asked to recall how much fear and pain they experienced during the first dental treatment.

RESULTS

The child's behaviour improved from the first dental treatment visit to the second in the intervention group but not in the control condition. When compared to the controls, those in the intervention group changed their memory of the fear they experienced at the first treatment and their memory of experienced pain.

CONCLUSIONS

Restructuring memory may be effective in reducing fear for future treatment, and is easily adaptable to clinical practice in other healthcare situations.

Unwarranted Assumptions about Children's Testimonial Accuracy

We examine eight unwarranted assumptions made by expert witnesses, forensic interviewers, and legal scholars about the reliability of children's eyewitness reports. The first four assumptions modify some central beliefs about the nature of suggestive interviews, age-related differences in resistance to suggestion, and thresholds necessary to produce tainted reports. The fifth unwarranted assumption involves the influence of both individual and interviewer factors in determining children's suggestibility. The sixth unwarranted assumption concerns the claim that suggested reports are detectable. The seventh unwarranted assumption concerns new findings about how children deny, disclose, and/or recant their abuse. Finally, we examine unwarranted statements about the value of science to the forensic arena. It is important not only for researchers but also expert witnesses and court-appointed psychologists to be aware of these unwarranted assumptions.

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

BACKGROUND

Needle-related procedures are a common source of pain and distress for children. Several psychological (cognitive-behavioral) interventions to help manage or reduce pain and distress are available; however, a previous comprehensive systematic review of the efficacy of these interventions has not been conducted.

OBJECTIVES

To assess the efficacy of cognitive-behavioral psychological interventions for needle-related procedural pain and distress in children and adolescents.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 4, 2005), MEDLINE (1966 to 2005), PsycINFO (1887 to 2005), EMBASE (1974 to 2005), the Cumulative Index to Nursing and Allied Health Literature (1982 to 2005), Web of Science (1980 to 2005), and Dissertation-Abstracts International (1980 to 2005). We also searched citation lists and contacted researchers via various electronic list-servers and via email requests.

SELECTION CRITERIA

Participants included children and adolescents aged two to 19 years undergoing needle-related procedures. Only randomized controlled trials (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 independently extracted data and assessed trial quality. Included studies were coded for quality using the Oxford Quality Scale devised by Jadad and colleagues. Standardized mean differences with 95% confidence intervals were computed for all analyses using RevMan 4.0 software.

MAIN RESULTS

Twenty eight trials with 1951 participants were included. Together, these studies included 1039 participants in treatment conditions and 951 in control conditions. The most commonly studied needle-procedures were immunizations and injections. The largest effect sizes for treatment improvement over control conditions exist for distraction (on self-reported pain, SMD -0.24 (95% CI -0.45 to -0.04), combined cognitive-behavioral interventions--reduced other-reported distress (SMD -0.88, 95% CI -1.65 to -0.12; and behavioral measures of distress (SMD -0.67, 95% CI -0.95 to -0.38) with hypnosis being the most promising--self-reported pain (SMD -1.47, 95% CI -2.67 to -0.27), with promising but limited evidence for the efficacy of numerous other psychological interventions, such as information/preparation, nurse coaching plus distraction, parent positioning plus distraction, and distraction plus suggestion.

AUTHORS' CONCLUSIONS

Overall, there is preliminary evidence that a variety of cognitive-behavioral interventions can be used with children and adolescents to successfully manage or reduce pain and distress associated with needle-related procedures. However, many of the included studies received lower quality scores because they failed to describe the randomization procedure and participant withdrawals or drop-outs from the study. Further RCTs need to be conducted, particularly for the many interventions for which we could not locate any trials.

The influence of another's perspective on children's recall of previously misconstrued events

Children's abilities to reframe their memories of events after hearing another child's perspective of the same events were examined, and links between memory reframing, cognitive ability, and social competence were explored. Nine- to 11-year-olds (N = 79) were told to imagine that the events in a narrated story happened to them. Next, they heard another story that described either the same events (experimental condition) or unrelated events (control condition) from another child's perspective. The children in the experimental group reframed their memories in light of the alternative perspective, whereas the children in the control condition did not. Children with higher cognitive scores had higher memory reframing scores and received higher social competence ratings than children with lower cognitive scores.