The Cochrane Library and procedural pain in children: an overview of reviews

Abstract

BackgroundProcedural pain in children is highly prevalent, a major source of pain, stress and anxiety, and can have negative short‐ and long‐term effects. Research addressing effective pain management strategies is complex, presenting challenges for clinically relevant synthesis.ObjectiveTo summarize Cochrane reviews assessing the effects of various interventions used for pain in non‐neonatal children undergoing painful medical procedures.MethodsThe Cochrane Database of Systematic Reviews was systematically searched for reviews of interventions for pain in children outside of the neonatal period, undergoing painful medical procedures. The type of data to be extracted was determined a priori, and a single author performed data extraction. The Cochrane Library was searched using the terms ‘procedural pain’ and ‘procedures’. Reviews examining acute procedural pain in older infants, children and adolescents were included. Interventions included topical anaesthetics (eutectic mixture of local anaesthetics and amethocaine), sweet tasting substances, cognitive therapy, behavioural therapy and combined cognitive‐behavioural therapy(CBT). Data on self‐reported, behavioural and observer pain intensity and pain distress were extracted.Main resultsFour systematic reviews were included in the overview. There was evidence that self‐reported pain [risk ratio (RR) 0.63; 95% confidence interval (CI) 0.45–0.87], behavioural measures of pain (RR 0.71; 95% CI 0.52–0.96) and all pain scales combined (RR 0.69; 95% CI 0.55–0.87) were significantly less with amethocaine than with eutectic mixture of local anaesthetics. Results of trials of other interventions are reported in this article but heterogeneity of the combined effects is high.Authors' conclusionsAmethocaine provides superior pain relief when compared with eutectic mixture of local anaesthetics for the procedure of intravenous cannulation. From the data contained in this overview, there is no current evidence of benefit supporting the use of 12% sucrose for older infants and toddlers or sweet gum for toddlers undergoing needle pain. Potentially efficacious nonpharmacological interventions may include distraction, hypnosis, combined cognitive‐behavioural interventions, non‐nutritive sucking and video distraction; however, further research is required as results are mixed. An integrated approach using multiple modalities encompassing both the physiological and psychological aspects of pain is compelling and warrants further study in paediatrics. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

“…Despite the availability of effective topical analgesic agents for urinary catheterization, which is known to be pain and anxiety provoking, 27,28 60% of physicians in our study reported providing no analgesia for pediatric urinary catheterizations. Similarly, although IV insertion is known to cause moderate pain in infants and many options exist to limit this pain, 15,20,21,25,29 only half of physicians reported that they ''often or always'' used analgesia for venipuncture. LP is another procedure for which multiple effective analgesic interventions exist and are recommended in the literature.…”

“…LP is another procedure for which multiple effective analgesic interventions exist and are recommended in the literature. 10,15,21,30,31 However, based on self-report, only two-thirds of Practice variation in pediatric pain 2014;16(5) 357 CJEM N JCMU physicians used topical anesthetic, and less than onethird used oral sucrose when performing an LP.…”

“…Topical anesthetic cream was available as part of a venipuncture protocol to only 5% of physicians, even though it has been definitively proven to be efficacious for multiple painful procedures. 10,13,15,21,25,30,38 In addition, half of physicians reported having either no screening policies for pain or were unaware of screening policies, and half reported no requirement for pain documentation in their EDs. This may be due to a lack of knowledge of existing policies as the commonly employed Canadian Triage and Acuity Scale (CTAS) includes documentation of a pain score for triaged patients.…”

“…[18][19][20] The medical literature has long demonstrated many effective pharmacologic and nonpharmacologic interventions (NPIs) for pediatric pain. 15,[21][22][23][24][25] The frequency and success of application of these interventions by Canadian pediatric emergency physicians has not been reported. The purpose of this study was to describe reported practice patterns for pediatric emergency medicine (PEM) physicians and to explore factors that facilitate or hinder pain management.…”

Clinical Hypnosis with Children and Adolescents—What? Why? How?: Origins, Applications, and Efficacy

“…It is also noteworthy that Cochrane and other systematic reviews support the efficacy of pediatric hypnosis for various clinical applications, including Curtis et al ., (2012) [112], Gold et al ., (2007) [113], Landier & Tse (2010) [114], McClaffery (2011) [115], Rickardson et al ., (2006) [116], Schnur et al ., (2008) [117], and Uman et al ., (2013) [118]. …”