Non‐pharmacological management of infant and young child procedural pain
Rebecca Pillai Riddell,Nicole Racine,Hannah Gennis,Kara Turcotte,Lindsay S. Uman,Rachel Elizabeth Horton,Sara Ahola Kohut,Jessica Hillgrove Stuart,Bonnie Stevens,Diana Lisi +9 more
TLDR
There is evidence that different non-pharmacological interventions can be used with preterms, neonates, and older infants to significantly manage pain behaviors associated with acutely painful procedures.Abstract:
Background
Infant acute pain and distress is commonplace. Infancy is a period of exponential development. Unrelieved pain and distress can have implications across the lifespan. This is an update of a previously published review in the Cochrane Database of Systematic Reviews, Issue 10 2011 entitled 'Non-pharmacological management of infant and young child procedural pain'.
Objectives
To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding kangaroo care, and music. Analyses were run separately for infant age (preterm, neonate, older) and pain response (pain reactivity, immediate pain regulation).
Search methods
For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 2 of 12, 2015), MEDLINE-Ovid platform (March 2015), EMBASE-OVID platform (April 2011 to March 2015), PsycINFO-OVID platform (April 2011 to February 2015), and CINAHL-EBSCO platform (April 2011 to March 2015). We also searched reference lists and contacted researchers via electronic list-serves. New studies were incorporated into the review. We refined search strategies with a Cochrane-affiliated librarian. For this update, nine articles from the original 2011 review pertaining to Kangaroo Care were excluded, but 21 additional studies were added.
Selection criteria
Participants included infants from birth to three years. Only randomised controlled trials (RCTs) or RCT cross-overs that had a no-treatment control comparison were eligible for inclusion in the analyses. However, when the additive effects of a non-pharmacological intervention could be assessed, these studies were also included. We examined studies that met all inclusion criteria except for study design (e.g. had an active control) to qualitatively contextualize results. There were 63 included articles in the current update.
Data collection and analysis
Study quality ratings and risk of bias were based on the Cochrane Risk of Bias Tool and GRADE approach. We analysed the standardized mean difference (SMD) using the generic inverse variance method.
Main results
Sixty-three studies, with 4905 participants, were analysed. The most commonly studied acute procedures were heel-sticks (32 studies) and needles (17 studies). The largest SMD for treatment improvement over control conditions on pain reactivity were: non-nutritive sucking-related interventions (neonate: SMD -1.20, 95% CI -2.01 to -0.38) and swaddling/facilitated tucking (preterm: SMD -0.89; 95% CI -1.37 to -0.40). For immediate pain regulation, the largest SMDs were: non-nutritive sucking-related interventions (preterm: SMD -0.43; 95% CI -0.63 to -0.23; neonate: SMD -0.90; 95% CI -1.54 to -0.25; older infant: SMD -1.34; 95% CI -2.14 to -0.54), swaddling/facilitated tucking (preterm: SMD -0.71; 95% CI -1.00 to -0.43), and rocking/holding (neonate: SMD -0.75; 95% CI -1.20 to -0.30). Fifty two of our 63 trials did not report adverse events. The presence of significant heterogeneity limited our confidence in the findings for certain analyses, as did the preponderance of very low quality evidence.
Authors' conclusions
There is evidence that different non-pharmacological interventions can be used with preterms, neonates, and older infants to significantly manage pain behaviors associated with acutely painful procedures. The most established evidence was for non-nutritive sucking, swaddling/facilitated tucking, and rocking/holding. All analyses reflected that more research is needed to bolster our confidence in the direction of the findings. There are significant gaps in the existing literature on non-pharmacological management of acute pain in infancy.read more
Citations
More filters
Journal ArticleDOI
Sucrose for analgesia in newborn infants undergoing painful procedures
TL;DR: The efficacy, effect of dose, method of administration and safety of sucrose for relieving procedural pain in neonates as assessed by validated composite pain scores, physiological pain indicators, and behavioural pain indicators are determined.
Journal ArticleDOI
Psychological interventions for needle‐related procedural pain and distress in children and adolescents
TL;DR: 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.
Journal ArticleDOI
Closeness and separation in neonatal intensive care.
Renée Flacking,Renée Flacking,Liisa Lehtonen,Gill Thomson,Anna Axelin,Anna Axelin,Sari Ahlqvist,Victoria Hall Moran,Uwe Ewald,Fiona Dykes +9 more
TL;DR: Some of the reasons why physical closeness and emotional closeness are crucial to the physical, emotional and social well‐being of both the infant and the parent are outlined.
Journal ArticleDOI
Prevention and management of procedural pain in the neonate: An update
Kristi L. Watterberg,James J. Cummings,William E. Benitz,Eric C. Eichenwald,Brenda B. Poindexter,Dan L. Stewart,Susan W. Aucott,Jay P. Goldsmith,Karen M. Puopolo,Kasper S. Wang,Joseph D. Tobias,Rita Agarwal,Corrie T M Anderso,Courtney Hardy,Anita Honkanen,Mohamed A. Rehman,Carolyn F. Bannister +16 more
TL;DR: Every health care facility caring for neonates should implement a pain-prevention program that includes strategies for minimizing the number of painful procedures performed and a pain assessment and management plan.
References
More filters
Book
Statistical Power Analysis for the Behavioral Sciences
TL;DR: The concepts of power analysis are discussed in this paper, where Chi-square Tests for Goodness of Fit and Contingency Tables, t-Test for Means, and Sign Test are used.
Journal ArticleDOI
Measuring inconsistency in meta-analyses
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Journal ArticleDOI
Pharmacological interventions for somatoform disorders in adults.
Maria Kleinstäuber,Michael Witthöft,Andrés Steffanowski,Harm W.J. van Marwijk,Wolfgang Hiller,Michael J. Lambert +5 more
TL;DR: A systematic review and meta-analysis of placebo-controlled studies examined the efficacy and tolerability of different types of antidepressants, the combination of an antidepressant and an antipsychotic, antipsychotics alone, or natural products in adults with somatoform disorders in adults to improve optimal treatment decisions.
Journal ArticleDOI
Interventions for latent autoimmune diabetes (LADA) in adults.
TL;DR: Two studies show SU leading to earlier insulin dependence and a meta-analysis of four studies with considerable heterogeneity showed poorer metabolic control if SU is prescribed for patients with LADA compared to insulin.
Chapter 8: Assessing risk of bias in included studies
TL;DR: The Cochrane Handbook for Systematic Reviews of Interventions (ISBN 978-0470057964) is published by John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England.
Related Papers (5)
Epidemiology and Treatment of Painful Procedures in Neonates in Intensive Care Units
Ricardo Carbajal,André Rousset,Claude Danan,Sarah Coquery,Paul Nolent,Sarah Ducrocq,Carole Saizou,Alexandre Lapillonne,Michèle Granier,Philippe Durand,Richard Lenclen,A Coursol,Philippe Hubert,Laure de Saint Blanquat,Pierre-Yves Boëlle,Daniel Annequin,Patricia Cimerman,Kanwaljeet J. S. Anand,Gérard Bréart +18 more
Prevention and management of procedural pain in the neonate: An update
Kristi L. Watterberg,James J. Cummings,William E. Benitz,Eric C. Eichenwald,Brenda B. Poindexter,Dan L. Stewart,Susan W. Aucott,Jay P. Goldsmith,Karen M. Puopolo,Kasper S. Wang,Joseph D. Tobias,Rita Agarwal,Corrie T M Anderso,Courtney Hardy,Anita Honkanen,Mohamed A. Rehman,Carolyn F. Bannister +16 more