Background
This review is an updated version of the original Cochrane review published in Issue 4, 2006. Needle-related procedures are a common source of pain and distress for children. Our previous review on this topic indicated that a number of psychological interventions were efficacious in managing pediatric needle pain, including distraction, hypnosis, and combined cognitive behavioural interventions. Considerable additional research in the area has been published since that time.

Objectives
To provide an update to our 2006 review assessing the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents.

Search methods
Searches of the following databases were conducted for relevant randomized controlled trials (RCTs): Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; PsycINFO; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Web of Science. Requests for relevant studies were also posted on various electronic list servers. We ran an updated search in March 2012, and again in March 2013.

Selection criteria
Participants included children and adolescents aged two to 19 years undergoing needle-related procedures. Only 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 extracted data and assessed trial quality and a third author helped with data extraction and coding for one non-English study. Included studies were coded for quality using the Cochrane Risk of bias tool. Standardized mean differences with 95% confidence intervals were computed for all analyses using Review Manager 5.2 software.

Main results
Thirty-nine trials with 3394 participants were included. The most commonly studied needle procedures were venipuncture, intravenous (IV) line insertion, and immunization. Studies included children aged two to 19 years, with the most evidence available for children under 12 years of age. Consistent with the original review, the most commonly studied psychological interventions for needle procedures were distraction, hypnosis, and cognitive behavioural therapy (CBT). The majority of included studies (19 of 39) examined distraction only. The additional studies from this review update continued to provide strong evidence for the efficacy of distraction and hypnosis. No evidence was available to support the efficacy of preparation and information, combined CBT (at least two or more cognitive or behavioural strategies combined), parent coaching plus distraction, suggestion, or virtual reality for reducing children's pain and distress. No conclusions could be drawn about interventions of memory alteration, parent positioning plus distraction, blowing out air, or distraction plus suggestion, as evidence was available from single studies only. In addition, the Risk of bias scores indicated several domains with high or unclear bias scores (for example, selection, detection, and performance bias) suggesting that the methodological rigour and reporting of RCTs of psychological interventions continue to have considerable room for improvement.

Authors' conclusions
Overall, there is strong evidence supporting the efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents, with no evidence currently available for preparation and information or both, combined CBT, parent coaching plus distraction, suggestion, or virtual reality. Additional research is needed to further assess interventions that have only been investigated in one RCT to date (that is, memory alteration, parent positioning plus distraction, blowing out air, and distraction plus suggestion). There are continuing issues with the quality of trials examining psychological interventions for needle-related pain and distress.

/pdf/psychological-interventions-for-needle-related-procedural-1ghadgun21.pdf

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

Background Numerous meta-analyses have been conducted on the topic of music and pain, with the latest comprehensive study published in 2006. Since that time, more than 70 randomized controlled trials (RCTs) have been published, necessitating a new and comprehensive review. Objective The aim of this meta-analysis was to examine published RCT studies investigating the effect of music on pain. Methods The present study included RCTs published between 1995 and 2014. Studies were obtained by searching 12 databases and hand-searching related journals and reference lists. Main outcomes were pain intensity, emotional distress from pain, vital signs, and amount of analgesic intake. Study quality was evaluated according to the Cochrane Collaboration guidelines. Results Analysis of the 97 included studies revealed that music interventions had statistically significant effects in decreasing pain on 0-10 pain scales (MD = -1.13), other pain scales (SMD = -0.39), emotional distress from pain (MD = -10.83), anesthetic use (SMD = -0.56), opioid intake (SMD = -0.24), non-opioid intake (SMD = -0.54), heart rate (MD = -4.25), systolic blood pressure (MD = -3.34), diastolic blood pressure (MD = -1.18), and respiration rate (MD = -1.46). Subgroup and moderator analyses yielded additional clinically informative outcomes. Conclusions Considering all the possible benefits, music interventions may provide an effective complementary approach for the relief of acute, procedural, and cancer/chronic pain in the medical setting.

The Effects of Music on Pain: A Meta-Analysis.

The coronavirus disease (COVID-19) pandemic has spread rapidly throughout the world and has had a long-term impact. The pandemic has caused great harm to society and caused serious psychological trauma to many people. Children are a vulnerable group in this global public health emergency, as their nervous systems, endocrine systems, and hypothalamic-pituitary-adrenal axes are not well developed. Psychological crises often cause children to produce feelings of abandonment, despair, incapacity, and exhaustion, and even raise the risk of suicide. Children with mental illnesses are especially vulnerable during the quarantine and social distancing period. The inclusion of psychosocial support for children and their families are part of the health responses to disaster and disaster recovery. Based on the biopsychosocial model, some children may have catastrophic thoughts and be prone to experience despair, numbness, flashbacks, and other serious emotional and behavioral reactions. In severe cases, there may be symptoms of psychosis or posttraumatic stress disorder. Timely and appropriate protections are needed to prevent the occurrence of psychological and behavioral problems. The emerging digital applications and health services such as telehealth, social media, mobile health, and remote interactive online education are able to bridge the social distance and support mental and behavioral health for children. Based on the psychological development characteristics of children, this study also illustrates interventions on the psychological impact from the COVID-19 pandemic. Even though the world has been struggling to curb the influences of the pandemic, the quarantine and social distancing policies will have long-term impacts on children. Innovative digital solutions and informatics tools are needed more than ever to mitigate the negative consequences on children. Health care delivery and services should envision and implement innovative paradigms to meet broad well-being needs and child health as the quarantine and social distancing over a longer term becomes a new reality. Future research on children's mental and behavioral health should pay more attention to novel solutions that incorporate cutting edge interactive technologies and digital approaches, leveraging considerable advances in pervasive and ubiquitous computing, human-computer interaction, and health informatics among many others. Digital approaches, health technologies, and informatics are supposed to be designed and implemented to support public health surveillance and critical responses to children's growth and development. For instance, human-computer interactions, augmented reality, and virtual reality could be incorporated to remote psychological supporting service for children's health; mobile technologies could be used to monitor children's mental and behavioral health while protecting their individual privacy; big data and artificial intelligence could be used to support decision making on whether children should go out for physical activities and whether schools should be reopened. Implications to clinical practices, psychological therapeutic practices, and future research directions to address current effort gaps are highlighted in this study.

/pdf/pediatric-mental-and-behavioral-health-in-the-period-of-39towpx12c.pdf

Pediatric Mental and Behavioral Health in the Period of Quarantine and Social Distancing With COVID-19.

Depression is a very common mood disorder, resulting in a loss of social function, reduced quality of life and increased mortality. Music interventions have been shown to be a potential alternative for depression therapy but the number of up-to-date research literature is quite limited. We present a review of original research trials which utilize music or music therapy as intervention to treat participants with depressive symptoms. Our goal was to differentiate the impact of certain therapeutic uses of music used in the various experiments. Randomized controlled study designs were preferred but also longitudinal studies were chosen to be included. 28 studies with a total number of 1,810 participants met our inclusion criteria and were finally selected. We distinguished between passive listening to music (record from a CD or live music) (79%), and active singing, playing, or improvising with instruments (46%). Within certain boundaries of variance an analysis of similar studies was attempted. Critical parameters were for example length of trial, number of sessions, participants' age, kind of music, active or passive participation and single- or group setting. In 26 studies, a statistically significant reduction in depression levels was found over time in the experimental (music intervention) group compared to a control (n = 25) or comparison group (n = 2). In particular, elderly participants showed impressive improvements when they listened to music or participated in music therapy projects. Researchers used group settings more often than individual sessions and our results indicated a slightly better outcome for those cases. Additional questionnaires about participants confidence, self-esteem or motivation, confirmed further improvements after music treatment. Consequently, the present review offers an extensive set of comparable data, observations about the range of treatment options these papers addressed, and thus might represent a valuable aid for future projects for the use of music-based interventions to improve symptoms of depression.

/pdf/reviewing-the-effectiveness-of-music-interventions-in-1cgel2fwry.pdf

Reviewing the Effectiveness of Music Interventions in Treating Depression

Background: In pediatric health care, non-pharmacological interventions such as music therapy have promising potential to complement traditional medical treatment options in order to facilitate recovery and well-being. Music therapy and other music-based interventions are increasingly applied in the clinical treatment of children and adolescents in many countries world-wide. The purpose of this overview is to examine the evidence regarding the effectiveness of music therapy and other music-based interventions as applied in pediatric health care. Methods: Surveying recent literature and summarizing findings from systematic reviews, this overview covers selected fields of application in pediatric health care (autism spectrum disorder; disability; epilepsy; mental health; neonatal care; neurorehabilitation; pain, anxiety and stress in medical procedures; pediatric oncology and palliative care) and discusses the effectiveness of music interventions in these areas. Results: Findings show that there is a growing body of evidence regarding the beneficial effects of music therapy, music medicine, and other music-based interventions for children and adolescents, although more rigorous research is still needed. The highest quality of evidence for the positive effects of music therapy is available in the fields of autism spectrum disorder and neonatal care. Conclusions: Music therapy can be considered a safe and generally well-accepted intervention in pediatric health care to alleviate symptoms and improve quality of life. As an individualized intervention that is typically provided in a person-centered way, music therapy is usually easy to implement into clinical practices. However, it is important to note that to exploit the potential of music therapy in an optimal way, specialized academic and clinical training and careful selection of intervention techniques to fit the needs of the client are essential.

Music Therapy and Other Music-Based Interventions in Pediatric Health Care: An Overview

Background: Individuals undergoing medical procedur es frequently experience pain and anxiety. Music-based interventions have the potential to help alleviate these symptoms. Objective: This r eview investigated the effects of music-based interventions (music therapy and music medicine) on pain and anxiety in children and adults undergoing medical procedures. Methods: This systematic r eview examined randomized controlled trial music intervention studies to manage patient-reported pain and/or anxiety during medical procedures. All studies were published in English and peer-reviewed journals. Quality and risk of bias were assessed using criteria from the Checklist to Evaluate a Report of a Nonpharmacological Trial (CLEAR-NPT). Results: Fifty studies met inclusion criteria, the majority of which (84%) had a high risk of bias. It was not possible to perfor m a meta-analysis because studies varied greatly in terms of medical procedure and intervention type. Results varied across studies, with approximately half (48%) indicating less anxiety for music intervention participants; fewer studies (36%) reported less pain for music intervention participants. Conclusions: Ther e is a need to clearly define and differentiate between music therapy and music medicine interventions in procedural support research. Further research is necessary to determine which patients would benefit most from music interventions during medical procedures, and which interventions are most beneficial. To improve research quality and reduce risk of bias, when designing studies investigators need to carefully consider factors related to design, including randomization, treatment allocation concealment, blinding outcome assessors, and intention-to-treat analysis. In addition, more detailed intervention reporting is needed when publishing results.

A systematic review of music-based interventions for procedural support.

https://www.childpsych.theclinics.com/article/S1056-4993(13)00017-5/pdf

Music therapy and music medicine for children and adolescents.

Over one million Americans are currently living with Parkinson's disease (PD), a degenerative neurological disorder caused by decreased dopamine in the substantia nigra (National Parkinson Foundation, 2010). Although PD is typically characterized by motor symptoms, impaired speech is a non-motor symptom experienced by many individuals with PD. According to recent estimates, approximately half of the population of individuals with PD has at least moderate speech impairments (Ho, lansek, Marigliani, Bradshaw, & Gates, 1998). Hypokinetic dysarthria is the term used to describe the voice and speech abnormalities associated with PD, which include reduced loudness or hypophonia, reduced prosodie pitch inflection, or monotone speech, hoarse voice, and imprecise articulation (Ramig, Fox, & Sapir, 2004). A study by Fox and Ramig (1997) on characteristics of speech impairment in individuals with PD found that individuals with PD tended to speak more softly (by 2 to 4 decibels) and had less intelligible speech than healthy controls.Perception of loudness is also affected by PD. Ho, Bradshaw, and lansek (2000) observed that people with PD tended to overestimate how loudly they were speaking to a greater degree than healthy controls. This difficulty with perception of loudness may lead many individuals with PD to deny that their speech is impaired. Instead, they may complain that others around them have impaired hearing, since they perceive their own speech as being adequately loud. Other speech characteristics of persons with PD may include higher frequency perturbation or "jitter," lower harmonic/noise ratio, lower frequency and intensity variability, lower phonational range, voice arrests, and struggle while speaking (Gamboa et al., 1997).Treatment for Speech Impairments in Individuals with PDSpeech therapy has been shown to be the most effective treatment for speech impairments resulting from PD. The Lee Silverman Voice Treatment (LSVT) program has received the greatest amount of attention in the research literature on speech treatments for individuals with PD (Spielman, Ramig, Mahler, Halpern, & Gavin, 2007). LSVT is used in over 30 countries to treat speech disorders in individuals with PD, and has been cited as highly effective in improving the loudness and clarity of speech of those affected by PD (Spielman et al., 2007). LSVT focuses on disordered voice, rather than articulation or rate of speech, by promoting increased phonatory effort, which increases amplitude (loudness). The treatment is based on five concepts which address the problems of decreased amplitude, decreased sensory perception of effort, and difficulty generating the right amount of effort to produce loud speech. The five concepts are: (a) focus on voice; (b) improve sensory perception of effort; (c) administer high effort treatment; (d) treat intensively; and (e) quantify treatment-related changes (Ramig et al., 2004).LSVT typically includes exercises to increase vocal fold adduction, such as pressing down on the arms of a chair while vocalizing, and drills to provide practice in sustaining maximum duration phonation and maximum fundamental frequency range. It also includes the application of LSVT principles when reading aloud and participating in conversation. The instruction "think loud" is used as a cue throughout treatment, and a decibel meter or another type of acoustic feedback mechanism is often used to provide the individual with feedback on their intensity level (Ramig, Countryman, Thompson, & Horii, 1995). In an LSVT session, an individual may be asked to practice maintaining the vowel /a/ for as long as they can, while monitoring their intensity and trying to keep it above a certain set decibel level. They may then be asked to read a passage out loud and continue to monitor their intensity. Drills geared toward increasing maximum fundamental frequency range may involve producing the lowest pitch possible and gliding up to the highest pitch possible. …

The Effects of Participation in a Group Music Therapy Voice Protocol (G-MTVP) on the Speech of Individuals with Parkinson's Disease

Background Children undergoing routine immunizations frequently experience severe distress, which may be improved through music therapy as procedural support. Objective The purpose of this study was to examine effects of live, cognitive-behavioral music therapy during immunizations on (a) the behaviors of children, their parents, and their nurses; and (b) parental perceptions. Methods Participants were children between the ages of 4 and 6 years (N = 58) who underwent immunizations, their parents (N = 62), and the nurses who administered the procedure (N = 19). Parent/child dyads were randomly assigned to receive music therapy (n = 29) or standard care (n = 29) during their immunization. Afterward, each parent rated their child's level of pain and the distress their child experienced compared to previous medical experiences. All procedures were videotaped and later viewed by trained observers, who classified child, parent, and nurse behaviors using the categories of the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R). Results Significant differences between the music therapy and control groups were found in rates of child coping and distress behaviors and parent distress-promoting behaviors. Parents of children who received music therapy reported that their child's level of distress was less than during previous medical experiences, whereas parents of children in the control group reported that their child's level of distress was greater. No significant differences between groups were found in parents' ratings of children's pain or in rates of nurse behavior. Conclusions Live, cognitive-behavioral music therapy has potential benefits for young children and their parents during immunizations.

/pdf/music-therapy-as-procedural-support-for-young-children-52dakf8lu6.pdf

Music Therapy as Procedural Support for Young Children Undergoing Immunizations: A Randomized Controlled Study

While literature exists supporting the use of music for health promotion, scholars have also noted the potential for music-induced harm and other maladaptive effects of music. Harm is a multifaceted construct that can include affective, behavioral, cognitive, identity, interpersonal, physical, and spiritual aspects. As music also represents a multifaceted experience, the relationship between music and harm is complex and can include numerous contextual-, deliverer-, music-, and recipient-based factors. Music-induced harm (MIH) also needs to be clearly defined to understand and protect against it. Therefore, the purpose of this article was to explore the numerous factors influencing how music can result in harm and develop a theoretical model that could be used to inform safe music practices. Drawing from existing models of emotional responses to music, music intervention reporting guidelines, therapeutic functions of music, and holistic wellness, we explored how the interplay between the deliverer, music, and recipient can result in various types of MIH in diverse contexts. We then developed the MIH model to integrate these factors and connect the model with the existing literature. The MIH model highlights the relevance of academic and clinical training, credentialing, occupational regulation, continuing education, and professional organizations that provide accredited curricular oversight to protect people from MIH. Implications for clinical application, limitations, and suggestions for future research are provided.

Olivia Swedberg Yinger

Papers

A systematic review of music-based interventions for procedural support.

Music therapy and music medicine for children and adolescents.

The Effects of Participation in a Group Music Therapy Voice Protocol (G-MTVP) on the Speech of Individuals with Parkinson's Disease

Music Therapy as Procedural Support for Young Children Undergoing Immunizations: A Randomized Controlled Study

It's...Complicated: A Theoretical Model of Music-Induced Harm.