Cochrane review: Psychological interventions for needle‐related procedural pain and distress in children and adolescents
Bibliographic record
Abstract
Abstract 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 (self‐reported pain: SMD = ‐0.24, 95% CI = ‐0.45 to ‐0.04), hypnosis (self‐reported pain: SMD = ‐1.47, 95% CI = ‐2.67 to ‐0.27; self‐reported distress: SMD = ‐2.20, 95% CI = ‐3.69 to ‐0.71; and behavioral measures of distress: SMD = ‐1.07, 95% CI = ‐1.79 to ‐0.35), and combined cognitive‐behavioral interventions (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). Promising but limited evidence exists for the efficacy of numerous other psychological interventions including: 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. Plain language summary Psychological interventions for needle‐related procedural pain and distress in children and adolescents Many psychological interventions are available for managing procedural pain and distress, the majority being cognitive, behavioral, or a combination of the two. Twenty eight trials with 1951 participants were included. There is evidence that certain psychological interventions are effective in reducing needle‐related pain and distress in children and adolescents. The largest effect sizes in favor of intervention exist for the efficacy of distraction, combined cognitive‐behavioral interventions, and hypnosis, in reducing pain and distress in children. There are insufficient data available to adequately assess the efficacy of several other psychological interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.006 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.012 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".