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Acute Pain | Chronic Pain | General

Distraction for childrens' pain and distress during medical procedures

Clinical bottom line:

Distraction interventions have a moderate beneficial effect on childrens' distress behaviours during medical procedures. There is no clear evidence that this is true for self-reported pain.


Distraction interventions for pain and distress

Distraction is one of the cognitive coping strategies used in managing childrens' pain. The aim is to divert attention away from unpleasant stimuli in an attempt to reduce pain and distress. This could be either passive (redirecting the patients attention), or active (involving the patient in a distraction task). A number of theories have been put forward to explain how this might reduce pain perception, centring on how cognitive processes may interfere with pain perception and pain mechanisms.

Systematic review

Kleiber C, Harper DC. Effects of distraction on childrens' pain and distress during medical procedures: a meta-analysis. Nurs Res 1999; 48: 44-49

Reviewers extracted mean and standard deviation for distraction and control groups. These data were used for meta-analysis according to the methods of Hunter and Schmidt. This generates an effect size with standard deviation for each trial, and weights this by sample size (but not methodological strength). For calculating effect size of randomised trials, the pooled standard deviation was used, and for trials with repeat measures design the control condition standard deviation was used.

Findings

Distraction interventions varied in complexity, including music, use of a toy, nonprocedural talk, story, cartoon, breathing and imagery exercises. Procedures varied in complexity, and included injection, burn treatment, venipuncture, bone marrow aspiration or lumbar puncture and dental procedures.

Pain

Ten trials of 535 patients were included in analysis of distraction for self-reported pain. The mean effect size was -0.62 (0.42 SD) on perceived pain, with 35% of the variance accounted for (90% credibility intervals -0.7 to 1.31).

Three trials looked at 268 children under the age of 8. The mean effect size was -0.47 (0.26 SD) on perceived pain, with 60% of the variance accounted for (90% credibility intervals -0.1 to 0.91).

Both effect sizes have negative values indicating that distraction decreased self-reported pain, but confidence intervals included zero, showing that results are not statistically significant.

Distress

Sixteen trials of 491 patients were included in analysis of distraction for self-reported pain. The mean effect size was -0.33 (0.17 SD) on perceived pain, with 74% of the variance accounted for (90% credibility intervals 0.05 to 0.61).

The effect size has a negative value indicating that distraction decreased observed distress behaviours.

In conclusion, although it is difficult to interpret effect sizes, the analysis suggests a moderate beneficial effects of distraction for distress behaviours.

Adverse effects

Reviewers stated that there was no risk.

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