Pain and distress outcomes in infants and children: a systematic review

Abstract

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 Influence of Stress and Anxiety on the Expectation, Perception and Memory of Dental Pain in Schoolchildren

“…Thus, stress and anxiety were relevant psychological factors associated with dental pain expectation in children. On the other hand, contrary to what was anticipated on the basis of the literature [13,14,30,31], stress and anxiety did not influence children’s perception of dental pain immediately after the dental procedure, nor the memory of dental pain six weeks after dental treatment.…”

Emerging Tools to Capture Self-Reported Acute and Chronic Pain Outcome in Children and Adolescents: A Literature Review

“…Advances in technology through electronic self-reported pain recording has the potential to address the existing limitations of self-reported paper pain outcome measures by providing the opportunity to complete intermittently throughout the course of the day with constant access to electronic devices [12]. Pain and distress outcomes in children have been extensively assessed for methodological quality [14,15]; however, further research is required in this paediatric field to facilitate the introduction of new smart technologies into daily clinical practice. This could potentially increase compliance and accuracy in recording self-reported pain levels in children and adolescents.…”

Technology in quest of the holy grail

“…Painful procedures, such as vaccinations, intravenous injections, laceration repair, and dressing changes for burn wounds are common in the pediatric emergency department (PED). Painful experiences during these procedures often lead to anxiety for patients, which can cause fear, and greatly affect compliance with care and future procedures [2].…”