Cochrane · systematic review · CD005179
Psychological interventions for needle‐related procedural pain and distress in children and adolescents
Birnie, KA, Noel, M, Chambers, CT, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Pain, Palliative and Supportive CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
42
current version
GRADE rated
20
No studies
9
Included studies
NR
No studies 9 · 21.4%Ungraded 13 · 31%Very low 13 · 31%Low 7 · 16.7%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Distraction compared to control for needle‐related procedural pain and distress in children and adolescents
Population: children aged 2‐19 years with mixed medical (acute or chronic illness) or generally healthy undergoing venipuncture, immunization, intravenous insertion, lumbar puncture, bone marrow aspiration, routine injection, allergy testing injections, or laceration repair
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐reported pain Distraction vs control | no estimate extracted | 30 studies · 2802 participants | Low Downgraded: risk of bias, inconsistency |
Self‐reported distress Distraction vs control | no estimate extracted | 4 studies · 426 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Observer‐reported pain Distraction vs control | no estimate extracted | 11 studies · 1512 participants | Very low Downgraded: risk of bias |
Observer‐reported distress Distraction vs control | no estimate extracted | 5 studies · 1067 participants | Very low Downgraded: risk of bias |
Behavioral measures‐ pain Distraction vs control | no estimate extracted | 4 studies · 309 participants | Low Downgraded: risk of bias, imprecision |
Behavioral measures‐ distress Distraction vs control | no estimate extracted | 7 studies · 500 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
CBT‐combined compared to control for needle‐related procedural pain and distress in children and adolescents
Population: children aged 3‐18 years with mixed medical (acute or chronic illness) or generally healthy undergoing immunization, intravenous insertion, venipuncture, bone marrow aspiration, insulin injection, or dental local anesthetic
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐reported pain CBT‐combined vs control | no estimate extracted | 14 studies · 1359 participants | Low Downgraded: risk of bias, inconsistency |
Self‐reported distress CBT‐combined vs control | no estimate extracted | 6 studies · 234 participants | Low Downgraded: risk of bias, imprecision |
Observer‐reported pain CBT‐combined vs control | no estimate extracted | 4 studies · 385 participants | Low Downgraded: risk of bias, imprecision |
Observer‐reported distress CBT‐combined vs control | no estimate extracted | 6 studies · 765 participants | Low Downgraded: risk of bias, inconsistency |
Behavioral measures‐ pain CBT‐combined vs control | no estimate extracted | 2 studies · 95 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Behavioral measures‐ distress CBT‐combined vs control | no estimate extracted | 11 studies · 1105 participants | Low Downgraded: risk of bias, inconsistency |
Hypnosis compared to control for needle‐related procedural pain and distress in children and adolescents
Population: children aged 3‐16 years with chronic illness (cancer) or generally healthy undergoing bone marrow aspirations, lumbar punctures, venipuncture, or local dental anesthetic
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐reported pain Hypnosis vs control | no estimate extracted | 5 studies · 176 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Self‐reported distress Hypnosis vs control | no estimate extracted | 5 studies · 176 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Observer‐reported pain Hypnosis vs control | no estimate extracted | NR | No studies |
Observer‐reported distress Hypnosis vs control | no estimate extracted | 1 study · 36 participants | Ungraded |
Behavioral measures‐ pain Hypnosis vs control | no estimate extracted | 2 studies · 69 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Behavioral measures‐ distress Hypnosis vs control | no estimate extracted | 6 studies · 193 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Preparation/information compared to control for needle‐related procedural pain and distress in children and adolescents
Population: children aged 3‐12 years with mixed medical (acute or chronic illness) or unclear diagnoses undergoing venipuncture or intravenous insertion
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐reported pain Preparation/information vs control | no estimate extracted | 4 studies · 313 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Self‐reported distress Preparation/information vs control | no estimate extracted | NR | No studies |
Observer‐reported pain Preparation/information vs control | no estimate extracted | 3 studies · 259 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Observer‐reported distress Preparation/information vs control | no estimate extracted | 1 study · 100 participants | Ungraded |
Behavioral measures‐ pain Preparation/information vs control | no estimate extracted | 1 study · 39 participants | Ungraded |
Behavioral measures‐ distress Preparation/information vs control | no estimate extracted | 1 study · 54 participants | Ungraded |
Breathing compared to control for needle‐related procedural pain and distress in children and adolescents
Population: children aged 6‐15 years who are generally healthy, undergoing surgery, or have leukemia undergoing venipuncture or lumbar puncture
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐reported pain Breathing vs control | no estimate extracted | 4 studies · 298 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Self‐reported distress Breathing vs control | no estimate extracted | NR | No studies |
Observer‐reported pain Breathing vs control | no estimate extracted | 1 study · 120 participants | Ungraded |
Observer‐reported distress Breathing vs control | no estimate extracted | 1 study · 120 participants | Ungraded |
Behavioral measures‐ pain Breathing vs control | no estimate extracted | NR | No studies |
Behavioral measures‐ distress Breathing vs control | no estimate extracted | NR | No studies |
Suggestion compared to control for needle‐related procedural pain and distress in children and adolescents
Population: children aged 3‐17 years who are generally healthy or have chronic illness undergoing intramuscular injection, immunization, or venipuncture
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐reported pain Suggestion vs control | no estimate extracted | 3 studies · 218 participants | Very low Downgraded: risk of bias, imprecision |
Self‐reported distress Suggestion vs control | no estimate extracted | 1 study · 78 participants | Ungraded |
Observer‐reported pain Suggestion vs control | no estimate extracted | 1 study · 78 participants | Ungraded |
Observer‐reported distress Suggestion vs control | no estimate extracted | 1 study · 20 participants | Ungraded |
Behavioral measures‐ pain Suggestion vs control | no estimate extracted | NR | No studies |
Behavioral measures‐ distress Suggestion vs control | no estimate extracted | NR | No studies |
Memory alteration compared to control for needle‐related procedural pain and distress in children and adolescents
Population: children aged 3‐18 years with chronic illness (leukemia) undergoing lumbar puncture
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐reported pain Memory alteration vs control | no estimate extracted | 1 study · 24 participants | Ungraded |
Self‐reported distress Memory alteration vs control | no estimate extracted | NR | No studies |
Observer‐reported pain Memory alteration vs control | no estimate extracted | 1 study · 42 participants | Ungraded |
Observer‐reported distress Memory alteration vs control | no estimate extracted | 1 study · 50 participants | Ungraded |
Behavioral measures‐ pain Memory alteration vs control | no estimate extracted | NR | No studies |
Behavioral measures‐ distress Memory alteration vs control | no estimate extracted | 1 study · 50 participants | Ungraded |