Using Distraction to Reduce Reported Pain, Fear, and Behavioral Distress in Children and Adolescents: A Multisite Study

Abstract

ISSUES AND PURPOSE. Distraction during painful procedures has been shown to be effective in previous studies, yet this simple intervention is not used routinely. This study examined the effectiveness and feasibility of distraction in reducing behavioral distress, pain, and fear during ven ipu nct u re or intravenous insert ion. DESIGN AND METHODS. A two-group randomized design with 384 children in 13 children's hospitals. RESULTS.Age was a significant factor in observed behavioral distress, reports of fear, and selfreported pain. The use of a kaleidoscope, however, did not significantly reduce pain or distress during venipuncture or IV insertion. PRACTICE IMPLICATIONS. Failure of the distraction intervention to reach statistical significance in this study is puzzling, given anecdotal reports of clinical efficacy. Methodological issues may have obscured actual differences between experimental and control groups.

Evaluation of a diclofenac transdermal patch for the attenuation of venous cannulation pain: a prospective, randomised, double‐blind, placebo‐controlled study

“…Cannulation pain has been ranked fifth out of 33 low-morbidity adverse clinical outcomes listed by expert anaesthetists when both clinical importance and frequency were considered [1]. Various methods like application of local anaesthetic cream, ethyl chloride spray, distraction tactics, the 'cough trick' and the Valsalva manoeuvre during venous cannulation have been tried in the attempt to minimise pain, but with unreliable results [2][3][4][5][6].…”

“…Cannulation pain has been ranked fifth out of 33 low-morbidity adverse clinical outcomes listed by expert anaesthetists when both clinical importance and frequency were considered [1]. Various methods like application of local anaesthetic cream, ethyl chloride spray, distraction tactics, the 'cough trick' and the Valsalva manoeuvre during venous cannulation have been tried in the attempt to minimise pain, but with unreliable results [2][3][4][5][6].The topical application of non-steroidal anti-inflammatory drugs (NSAIDs) has been reported to be effective in decreasing both acute and chronic pain [7]. Application of NSAID gel to the venous cannulation site has been reported to decrease the incidence of thrombophlebitis [8] but a literature search did not reveal any study evaluating the efficacy of the application of a NSAID patch on venous cannulation pain.…”

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

“…Literature on the measurement of children's procedural pain in the ED setting was limited for use during clinical studies that attempted to validate pharmacological, nonpharmacological, or multimodal interventions (Adriansson, Suserud, & Bergbom, 2004;Babl, Mandrawa, O'Sullivan, & Crellin, 2008;Carlson et al, 2000;Cavender, Goff, Hollon, & Guzzetta, 2004;Kissoon, McGrath, & Glebe, 1990;McErlean, Bartfield, Karunakar, Whitman, & Turley, 2003;Schultz, Strout, Jordan, & Worthing, 2002;Sinha, Christopher, Fenn, & Reeves, 2006). No studies were located that documented practice patterns for pain measurement of pediatric patients during painful procedures in the ED setting.…”

“…While there are a multitude of research based evidence that has examined the efficacy of using both pharmacological (Cregin et. al., 2008;D'Arcy, 2007;Meunier-Sham, & Ryan, 2003) and non-pharmacological (Carlson, Broome, & Vessey, 2000;D'Arcy, 2007;Lassetter, 2006) interventions, there remains a gap between available pediatric procedural pain management and actual practice in the emergency department clinical setting (MacLean et al, 2007;Ramponi, 2009).…”

“…The impact of attitudes, beliefs, and knowledge contact with children presenting for non-emergency illness and injury care and spend more time with patients in pain than any other healthcare professional (Carlson et al, 2000).…”