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Acute Pain | Chronic Pain | General

Non-pharmacological management of acute paedriatric pain

Clinical bottom line:

Meta-analysis not designed to establish best forms of paedriatric pain management. No conclusion possible.


Management of acute paedriatric pain

A number of different interventions for the management of childrens' response to painful clinical events have been developed. These interventions are mainly designed for outpatient clinics, and usually involve increasing cognitive, affective or physical skills of children.

Systematic review

Broome ME, Lillis PP. A descriptive analysis of the pediatric pain management research. Appl Nurs Res 1989; 2:74-81.

Broome ME, Lillis PP, Smith MC. Pain interventions with children: a meta analysis of research. Nurs Res 1989; 38:154-8.

Included trials were pain management trials in paedriatric patients; interventions designed to reduce childrens' distress to pain; groups size at least 10; age from birth to 18 years; sufficient data to compute effect size. Interventions used a variety of methods to provide factual and/or sensory information before the painful event to explain what would happen and how it might feel.

Reviewers completed a descriptive report (Broome and Lillis, 1989) and a meta-analysis (Broome et al, 1989). The descriptive report provided incomplete information on trials, conditions and outcomes. The information given is set out in Table 1. Main findings are those stated in the original reports. The meta-analysis examined effect size of all trials together. This included a diverse range of interventions (Table 1 lists some of them). The results of the meta-analysis are therefore not useful in establishing how best to manage paedriatric pain.

Table 1: Non-pharmacological interventions for the management of acute pain in children
Trial Painful event Intervention Main finding Outcome measures used
Intervention versus placebo      
Machen and Johnson (1974) Dental Desensitisation vs. placebo Intervention better than control Increased positive behaviours
    Model Learning vs. placebo Intervention better than control Increased positive behaviours
Fassler (1985) Preop. Injection Cognitive information vs. placebo Intervention better than control Decreased pulse rate, decreased distress behaviour, decreased perceived pain
Broome and Endsley (1987) Fingerstick Sensory and procedural preparation vs. placebo No difference between intervention and control Behavioural measures
Siegel and Peterson (1980) Dental Relaxation and imagery training vs. Placebo Relaxation and imagery training better than placebo decreased distress behaviours, decreased anxiety and discomfory ratings, decreased physiological arousal
Nocella and Kaplan (1982) Did not state Relaxation training vs. Placebo Intervention better than control Decreased distress behaviours
Intervention versus intervention      
Machen and Johnson (1974) Dental Desensitisation vs. Model Learning No difference between conditions Behavioural measures
Lende (1971) Blood test Book vs. puppet show vs. discussion No difference between conditions Behavioural measures
Johnson (1975) cast removal taped message with sensory and procedural information vs. procedural information alone Sensory+procedural information better than prodedural information alone Decreased behavioural distress
Fernald and Corry (1981) Fingerstick/venipuncture Sensory and procedural information plus validation of feelings vs. procedural information alone Sensory+prodecural+validation better than procedural alone Increased positive/decreased negative behaviour
Siegel and Peterson (1980) Dental Relaxation and imagery training vs. sensory information No difference between conditions Behavioural and physiological measures
Nocella and Kaplan (1982) Did not state Relaxation training vs. attention-control Relaxation better than attention-control Decreased distress behaviours
Parental presence/absence      
Shaw and Routh (1982) Immunisation Parent present vs absent Absent better than present Increased negative responses with parent present
Broome (1984) Immunisation Parent present vs absent No difference Behavioural measures
Frankl (1962) dental Parent present vs absent No difference with older children Parent present better than absent with toddlers Behavioural distress
Vernon (1965) Anaesthesia induction Parent present vs absent Present better than absent Increased cooperative behaviour

Adverse effects

Did not state.

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