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

• Published in: Cochrane database of systematic reviews 2018-10, Vol.10 (10), p.CD005179-CD005179
• Main Authors: Birnie, Kathryn A, Noel, Melanie, Chambers, Christine T, Uman, Lindsay S, Parker, Jennifer A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anxiety - prevention & control; Anxiety - psychology; Central Venous Catheters - adverse effects; Child; Child health; Child, Preschool; Cognitive Behavioral Therapy - methods; Humans; Hypnosis; Immunization; Needles; Orthopaedics & trauma; Pain & anaesthesia; Pain, Procedural - prevention & control; Pain, Procedural - psychology; Phlebotomy - psychology; Punctures - psychology; Randomized Controlled Trials as Topic; Self Report
• ISSN: 1469-493X
• DOI: 10.1002/14651858.cd005179.pub4

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