Non-pharmacological management of acute paedriatric pain
Clinical bottom line:Meta-analysis not designed to establish best forms of paedriatric pain management. No conclusion possible.
Management of acute paedriatric pain
A number of different interventions for the management of childrens' response to painful clinical events have been developed. These interventions are mainly designed for outpatient clinics, and usually involve increasing cognitive, affective or physical skills of children.
Systematic review
Broome ME, Lillis PP. A descriptive analysis of the pediatric pain management research. Appl Nurs Res 1989; 2:74-81.
Broome ME, Lillis PP, Smith MC. Pain interventions with children: a meta analysis of research. Nurs Res 1989; 38:154-8.
- Date review completed: pre 1989
- Number of trials included: 27 (5 unpublished)
- Number of patients: not stated
- Control group: placebo or active control
- Main outcomes: reduced distress to painful event (behavioural, physiological and self-report measures)
Included trials were pain management trials in paedriatric patients; interventions designed to reduce childrens' distress to pain; groups size at least 10; age from birth to 18 years; sufficient data to compute effect size. Interventions used a variety of methods to provide factual and/or sensory information before the painful event to explain what would happen and how it might feel.
Reviewers completed a descriptive report (Broome and Lillis, 1989) and a meta-analysis (Broome et al, 1989). The descriptive report provided incomplete information on trials, conditions and outcomes. The information given is set out in Table 1. Main findings are those stated in the original reports. The meta-analysis examined effect size of all trials together. This included a diverse range of interventions (Table 1 lists some of them). The results of the meta-analysis are therefore not useful in establishing how best to manage paedriatric pain.
| Table 1: Non-pharmacological interventions for the management of acute pain in children | ||||
| Trial | Painful event | Intervention | Main finding | Outcome measures used |
| Intervention versus placebo | ||||
| Machen and Johnson (1974) | Dental | Desensitisation vs. placebo | Intervention better than control | Increased positive behaviours |
| Model Learning vs. placebo | Intervention better than control | Increased positive behaviours | ||
| Fassler (1985) | Preop. Injection | Cognitive information vs. placebo | Intervention better than control | Decreased pulse rate, decreased distress behaviour, decreased perceived pain |
| Broome and Endsley (1987) | Fingerstick | Sensory and procedural preparation vs. placebo | No difference between intervention and control | Behavioural measures |
| Siegel and Peterson (1980) | Dental | Relaxation and imagery training vs. Placebo | Relaxation and imagery training better than placebo | decreased distress behaviours, decreased anxiety and discomfory ratings, decreased physiological arousal |
| Nocella and Kaplan (1982) | Did not state | Relaxation training vs. Placebo | Intervention better than control | Decreased distress behaviours |
| Intervention versus intervention | ||||
| Machen and Johnson (1974) | Dental | Desensitisation vs. Model Learning | No difference between conditions | Behavioural measures |
| Lende (1971) | Blood test | Book vs. puppet show vs. discussion | No difference between conditions | Behavioural measures |
| Johnson (1975) | cast removal | taped message with sensory and procedural information vs. procedural information alone | Sensory+procedural information better than prodedural information alone | Decreased behavioural distress |
| Fernald and Corry (1981) | Fingerstick/venipuncture | Sensory and procedural information plus validation of feelings vs. procedural information alone | Sensory+prodecural+validation better than procedural alone | Increased positive/decreased negative behaviour |
| Siegel and Peterson (1980) | Dental | Relaxation and imagery training vs. sensory information | No difference between conditions | Behavioural and physiological measures |
| Nocella and Kaplan (1982) | Did not state | Relaxation training vs. attention-control | Relaxation better than attention-control | Decreased distress behaviours |
| Parental presence/absence | ||||
| Shaw and Routh (1982) | Immunisation | Parent present vs absent | Absent better than present | Increased negative responses with parent present |
| Broome (1984) | Immunisation | Parent present vs absent | No difference | Behavioural measures |
| Frankl (1962) | dental | Parent present vs absent | No difference with older children Parent present better than absent with toddlers | Behavioural distress |
| Vernon (1965) | Anaesthesia induction | Parent present vs absent | Present better than absent | Increased cooperative behaviour |
Adverse effects
Did not state.
Related topics
- Identifier AP051 - 10460 PAEDRIATRIC PAIN MANAGEMENT: Jul-99