The crossover study design provides a better understanding of the power effects of distraction for acute pain management. Audiovisual distraction was a powerful and effective non-pharmacological intervention for pain relief in paediatric inpatients. The effects were detected in subsequent acute painful procedures.

The present study characterized the opinions of health professionals about strategies for assessing and managing pediatric pain in a public teaching hospital. The sample consisted of 92 health professionals who worked in pediatric wards, pediatric intensive care, and neonatal intensive care. The sample included 45 doctors, 18 nurses, 16 psychologists, eight physiotherapists, and five occupational therapists. Data were collected through a self-administered questionnaire that included 22 open questions on the following topics: pain assessment, pharmacological management, and non-pharmacological interventions. Each area was analyzed with regard to actions, resources, gaps, and needs. The questionnaire was developed based on the principles of Strategic Planning. Two trained researchers analyzed the thematic content of all of the responses. With regard to actions and resources, 33% of the respondents mentioned the use of instruments for pain assessment, 73% reported that they prescribed pharmacological treatments for symptoms of pain, and 26% reported the use of non-pharmacological interventions for the relief of pain. The professionals predominantly reported a lack of training for pain assessment and management, standardized protocols, and human and material resources. Consequently, 96% of the professionals reported the necessity for educational training and standardized implementation guidelines for pain assessment services. These findings provide a baseline of the health professional's opinions of pain issues, which are essential for implementing and increasing pain assessment and management policies institutionally.

The aim of the present study was to systematically review the recent literature about pain and distress outcomes in children and critically analyze the methodological quality of the reports. The systematic review was based on the PRISMA statement and performed by selecting articles that are indexed in scientific databases. The methodological quality of reports was examined using STROBE statement, for observational studies, and CONSORT statement, for randomized controlled trials. The PedIMMPACT consensus was used to evaluate the psychometric quality of pain instruments. We analyzed 23 empirical studies, including 14 randomized controlled trials, seven cross-sectional studies, and two studies with cohort designs. Fourteen studies included preschool- and schoolchildren, and nine studies included infants. Regarding studies with infants, pain responses were evaluated by heart rate, crying and behavioral observation scales, and distress was evaluated only by salivary cortisol. Four-handed care and sensorial saturation interventions were used to evaluate efficacy to reduce pain and distress responses. Concerning studies with children, both pain and distress responses were evaluated by self- and hetero-reports, behavioral observation and/or physiological measures. Distraction was effective for reducing pain and distress during burn dressing changes and needle procedures, and healing touch intervention reduced distress and pain in chronic patients. All of the studies scored at least 60% in the methodological quality assessment. The pain outcomes included measures of validity that were classified as well-established by the PedIMMPACT. This systematic review gathers scientific evidence of distress-associated pain in children. Pain and distress were measured as distinct constructs, and their associations were poorly analyzed.

The aim of the present study was to systematically review the recent literature regarding the effectiveness of nonpharmacological interventions for acute pain relief in children of preschool and school age. This literature review was performed by selecting scientific articles that are indexed in main databases. The keywords that were used for the search were the following: pain and nonpharmacological and management, pain and nonpharmacological and intervention, acute and procedural and pain, and pain and intervention and distraction. We analyzed 12 empirical articles: 7 were randomized controlled trials and 5 were clinical trials with no randomization. The pain outcomes of the studies included validity measures by self-report, heteroreport, and behavioral observation. All 12 studies included at least 1 intervention that used a distraction strategy. Pain management that used audiovisual distraction, virtual reality, distraction with objects (e.g., cards, a kaleidoscope, and a soft ball), distraction performed by parents or professionals, and multimodal distraction device interventions significantly reduced pain scores in children who underwent different painful procedures. The findings of the present review suggest that distraction may be recommended as a simple and efficient nonpharmacological acute pain relief strategy to be implemented in clinical practice in pediatric care settings. Future studies should be conducted to assess different medical procedures and settings to better generalize the results.

Neuropsychological impairment was observed in 40% of children who suffered a TBI and was associated with late MRI abnormalities.

AgradecimentosAgradeço inicialmente à Deus pelas oportunidades de aprendizado e conhecimento que tem me proporcionado, pela sua presença constante em minha vida, me sustentando durante todos os desafios enfrentados durante o percurso deste trabalho.Ao Departamento de Neurociências e Ciências do Comportamento da FMRP-USP, pelo apoio dispensado durante a realização do Mestrado.À Secretaria de Pós-graduação e à Secretaria de Pós-graduação em Saúde Mental da FMRP-USP, pela atenção e auxílio no decorrer do Mestrado.Aos professores: Profa. Dra. Sônia Enumo, Profa. Dra. Flávia Osório e Prof. Dr. Jair Lício pelas contribuições enriquecedoras e experiência desafiante no Exame de Geral de Qualificação. Agradeço especialmente o valioso auxílio do Prof. Dr. Jair Lício na análise dos dados.Ao Prof. Dr. Allen Finley pela oportunidade internacional que me proporcionou, pelos valiosos ensinamentos e incentivos ao meu crescimento acadêmico.Ao Programa Pain in Child Health -PICH, pela oportunidade de participar de um projeto brilhante e inspirador que transformou a minha visão sobre o fazer pesquisa científica. Agradeço especialmente o apoio dos mentores por compartilharem experiências e conhecimentos durante os treinamentos anuais e visitas técnicas aos laboratórios de pesquisa. Aos colegas trainees pela acolhida e oportunidades de trocas de vivências internacionais.À Mayday Foundation Canadian Institutes for Health Research, pelo subsídio financeiro à minha participação nos treinamentos anuais do PICH, nos congressos internacionais na área de dor pediátrica e nas visitas técnicas aos laboratórios de pesquisa.À equipe de enfermagem da Pediatria do HCFMRP-USP, pelo apoio na coleta de dados, especialmente à Letícia pela disponibilidade em ajudar diariamente durante todo processo.Aos pacientes e familiares pela disponibilidade e interesse em participar do estudo, possibilitando que esta pesquisa se concretizasse.Às amigas de laboratório pelo apoio e companheirismo nessa jornada: Rafaela Cassiano, Fabíola Dantas, Maria Eduarda Pedro, Elisa Altafim, Doane Servidone, Ana Cláudia Castro, Martina Brom, Renata Freitas e Luciana Consentino.Às amigas Beatriz Valeri e Fernanda Doca, irmãs do PICH, pela doce acolhida nos meus primeiros desafios acadêmicos internacionais e pelo compartilhamento de experiências e conhecimentos no universo da dor pediátrica.À querida amiga Cláudia Gaspardo, pelas inúmeras vezes que me auxiliou, sempre demonstrando carinho e humildade ao dividir sua rica experiência acadêmica! Às minhas companheiras de trabalho do HCFMRP-USP, obrigada por compartilharem sonhos, realizações e desafios diários.Às aprimorandas do Programa de Desenvolvimento na Área da Saúde do HCFMRP-USP, pela disponibilidade em aprender e auxiliar na minha formação como supervisora.Ao meu pai Valmir que me ensinou a ter empenho, persistência e dedicação nos projetos de vida. A você pai querido, muito obrigada por valorizar o meu estudo, incentivar o meu crescimento e oferecer as grandes oportunidades de vida! À minha mãe Solange que me ensinou a s...

The present cross-sectional study aimed to evaluate acute pain intensity and distress behavior in children aged one to seven years hospitalized in the Pediatric Intensive Care Unit (PICU), and to compare groups differentiated by: type of disease (acute vs. chronic), type of treatment (surgical vs. clinical), developmental phase (1-3 years vs. 4-7 years), and gender (boys vs. girls). The secondary objective of the study was to compare two pain and distress assessments performed during painful procedures on different days to verify the behavioral reactivity of the children during the hospitalization. The study sample consisted of 44 children (59% boys) aged between one and seven years (mean = 38 months ± 23), who were hospitalized at the