Psychological interventions for needle-related procedural pain and distress in children and adolescents

 

Abstract

Background

Needle-related procedures are a common source of pain and distress for children. Several psychological (cognitive-behavioral) interventions to help manage or reduce pain and distress are available; however, a previous comprehensive systematic review of the efficacy of these interventions has not been conducted.

Objectives

To assess the efficacy of cognitive-behavioral psychological interventions for needle-related procedural pain and distress in children and adolescents.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 4, 2005), MEDLINE (1966 to 2005), PsycINFO (1887 to 2005), EMBASE (1974 to 2005), the Cumulative Index to Nursing and Allied Health Literature (1982 to 2005), Web of Science (1980 to 2005), and Dissertation-Abstracts International (1980 to 2005). We also searched citation lists and contacted researchers via various electronic list-servers and via email requests.

Selection criteria

Participants included children and adolescents aged two to 19 years undergoing needle-related procedures. Only randomized controlled trials (RCTs) with at least five participants in each study arm comparing a psychological intervention group with a control or comparison group were eligible for inclusion.

Data collection and analysis

Two review authors independently extracted data and assessed trial quality. Included studies were coded for quality using the Oxford Quality Scale devised by Jadad and colleagues. Standardized mean differences with 95% confidence intervals were computed for all analyses using RevMan 4.0 software.

Main results

Twenty-eight trials with 1951 participants were included. Together, these studies included 1039 participants in treatment conditions and 951 in control conditions. The most commonly studied needle-procedures were immunizations and injections. The largest effect sizes for treatment improvement over control conditions exist for distraction (self-reported pain: SMD = -0.24, 95% CI = -0.45 to -0.04), hypnosis (self-reported pain: SMD = -1.47, 95% CI = -2.67 to -0.27; self-reported distress: SMD = -2.20, 95% CI = -3.69 to -0.71; and behavioral measures of distress: SMD = -1.07, 95% CI = -1.79 to -0.35), and combined cognitive-behavioral interventions (other-reported distress: SMD = -0.88, 95% CI = -1.65 to -0.12; and behavioral measures of distress: SMD = -0.67, 95% CI = -0.95 to -0.38). Promising but limited evidence exists for the efficacy of numerous other psychological interventions including: information/preparation, nurse coaching plus distraction, parent positioning plus distraction, and distraction plus suggestion.

Authors' conclusions

Overall, there is preliminary evidence that a variety of cognitive-behavioral interventions can be used with children and adolescents to successfully manage or reduce pain and distress associated with needle-related procedures. However, many of the included studies received lower quality scores because they failed to describe the randomization procedure and participant withdrawals or drop-outs from the study. Further RCTs need to be conducted, particularly for the many interventions for which we could not locate any trials.

 

Plain language summary

Psychological interventions for needle-related procedural pain and distress in children and adolescents

Many psychological interventions are available for managing procedural pain and distress, the majority being cognitive, behavioral, or a combination of the two. Twenty eight trials with 1951 participants were included. There is evidence that certain psychological interventions are effective in reducing needle-related pain and distress in children and adolescents. The largest effect sizes in favor of intervention exist for the efficacy of distraction, combined cognitive-behavioral interventions, and hypnosis, in reducing pain and distress in children. There are insufficient data available to adequately assess the efficacy of several other psychological interventions.

 

摘要

背景

對於有對打針相關疼痛與壓力的兒童和青少年做一個心理方面介入治療

有與打針相關的疼痛與壓力對兒童來說是常見的。有幾項心理(認知行為)介入方式來幫助處理和減少疼痛與壓力是可行的; 但是, 對於這些介入治療效果之前沒有做全面系統性的回顧。

目標

針對有對打針相關疼痛與壓力的兒童和青少年來評估認知行為的心理治療效果。

搜尋策略

我們搜尋了Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue4, 2005), MEDLINE (1966 to 2005), PsycINFO (1887 to 2005), EMBASE (1974 to2005), the Cumulative Index to Nursing and Allied Health Literature (1982 to2005), Web of Science (1980 to 2005), and DissertationAbstracts International(1980 to 2005).。我們也搜尋了列舉名單和並且透過各種各樣的電子方式和電子郵件與研究人員聯繫。

選擇標準

受試者包括孩童和青少年年齡從2歲到19 歲接受打針相關的步驟。一項隨機控制試驗(RCTs) 至少有五位受試者來對心理介入治療組與控制做比較或比較哪一組比較是適合納入條件的。

資料收集與分析

二位回顧作者分別擷取了資料和評估了試驗的品質。納入研究的品質是使用由Jadad等人所構想的Oxford Quality Scale。所有分析都使用Rev Man 4.0 軟體來計算標準平均差有著95% 信賴區間。

主要結論

二十八項試驗共1951個受試者被納入。加起來, 這些研究包括1039個受試者在治療組和951受試者在控制組。最常學習的打針相關步驟是免役和注射。最大的治療樣本在改善控制組方面是分散注意力(自已痛苦: SMD = −0.24,95% CI = −0.45 到−0.04),催眠(自已被報告痛苦: SMD = −1.47, 95% CI = −2.67 到二十八項試驗共1951個受試者被納入。加起來,這些研究包括1039個受試者在治療組和951受試者在控制組。最常學習的打針相關步驟是免役和注射。最大的治療樣本在改善控制組方面是分散注意力(自已痛苦:SMD = −0.24,95% CI = −0.45到−0.04),催眠(自已被報告痛苦:SMD = −1.47, 95% CI = −2.67到−0.27; 自已報告有壓力SMD = −2.20, 95% CI = −3.69到−0.71;而行為量測到壓力:SMD = −1.07, 95% CI = −1.79到−0.35),而合併認知行為的介入(其他報告壓力:SMD = −0.88, 95%CI = 1.65到−0.12;並且行為量測到壓力:SMD = −0.67, 95% CI = −0.95到−0.38)。在其它心理介入治療方面有可能有效果但缺乏有力的證據包括:事前告知/準備、護理人員輔導加上分散注意力、父母安撫加上分散注意力和分散注意力加上建議。−0.27; 自已報告有壓力: SMD = −2.20, 95% CI = −3.69 到−0.71;而行為量測到壓力: SMD = −1.07, 95% CI = −1.79 到−0.35), 而合併認知行為的介入(其他報告壓力: SMD = −0.88, 95% CI = −1.65 到−0.12; 並且行為量測到壓力: SMD = −0.67, 95% CI = −0.95 到−0.38)。在其它心理介入治療方面有可能有效果但缺乏有力的證據包括: 事前告知/準備 、護理人員輔導加上分散注意力, 父母安撫加上分散注意力, 和分散注意力加上建議。

作者結論

總之, 有初步證據顯示有各種各樣的認知行為的介入可能使孩子和青少年成功地面對或減少與打針相關的疼痛。然而, 許多納入的研究有著較低品質的分數因為他們沒有使用隨機的方式而受試者退縮或從研究中退出。需要更多的RCTs實驗,特別在我們不能找出任何證據的介入治療。

翻譯人

本摘要由三軍總醫院詹舜名翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

心理介入方式來幫助兒童和青少年處理和減少疼痛與打針相關壓力。用來處理打針相關的痛苦和壓力,許多心理介入是可行的,大部份是認知,行為相關的或合併兩者。二十八項試驗納入1951 個受試者。有證據證明某些心理介入治療在減少對於孩童和青少年與打針相關的痛苦和壓力是有效的。介入治療以分散注意力、合併認知行為的介入治療和催眠是減少兒童和青少年打針相關痛苦和壓力具有最大的效果。沒有足夠的數據資料來適當地評估其它心理介入治療效果。