Psychological Interventions for Needle-Related Procedural Pain and Distress in Children and Adolescents

A Cochrane review [Abstract] 1 included 59 studies with a total of 5 550 subjects. The most commonly studied needle-procedures were venipuncture, intravenous (IV) line insertion, and immunizations. Studies included children aged 2 to 19 years, with few trials focused on adolescents. Most commonly studied psychological interventions for needle procedures were distraction (32 studies), combined cognitive behavioral therapy (CBT, 18), and hypnosis (8). Preparation/information (4), breathing (4), suggestion (3), and memory alteration (1) were also included. Distraction interventions included watching cartoons or a movie, listening to music or a spoken story, interactive handheld computer or video games, distraction cards, virtual reality, playing with a toy, parent distraction, medical clown, squeezing a rubber ball, or a combination or selection of various distractors such as toys, books, cartoons, games, or music.

Distraction reduced self-reported pain (SMD -0.56, 95% CI -0.78 to -0.33, statistical heterogeneity I² =87%; 30 studies, n=2 802), and distress (SMD −0.82, 95% CI −1.45 to −0.18, I² =89%; 4 studies, n=426), observer-reported pain and distress, and behavioral distress. Distraction was not efficacious for behavioral pain.

Hypnosis reduced self-reported pain (SMD −1.40, 95% CI −2.32 to −0.48, I² =85%; 5 studies, n=176) and distress (SMD −2.53, 95% CI −3.93 to −1.12, I² =91%; 5 studies, n=176), and behavioral distress, but not behavioral pain.

CBT was efficacious for observer-reported pain (SMD −0.52, 95% CI −0.73 to −0.30; 4 studies, n=385) and behavioral distress (SMD −0.40, 95% CI −0.67 to −0.14, I² =70%; 11 studies, n=1 105), but not self-reported pain, self-reported distress, observer-reported distress, or behavioral pain.

There was efficacy of breathing interventions for self‐reported pain (SMD −1.04, 95% CI −1.86 to −0.22, I² =90%; 4 studies, n=298). There was no effect for preparation/information or suggestion for any pain or distress outcome. Adverse events of respiratory difficulties were only reported in one breathing intervention.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding) and by inconsistency (statistical heterogeneity).

References

• Birnie KA, Noel M, Chambers CT et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2018;(10):CD005179. [PubMed]