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Updated: May 11, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
A prospective randomised control study: reduction of children's pain expectation using a picture book during blood
B Zieger1, M Praskova, E Busse
1Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg, Germany. barbara.zieger@uniklinikfreiburg.de
Insights
A picture book significantly reduced children's pain expectation before blood draws. This intervention proved effective for children not receiving local anesthesia, suggesting its practical application in pediatric care.
Area of Science:
- Pediatric Medicine
- Psychology
- Pain Management
Background:
- Blood draws are a common source of pain and stress for children.
- Effective strategies are needed to mitigate procedural pain in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of a picture book intervention in reducing children's pain expectation before blood draws.
- To assess the impact of the picture book on children's actual pain experience and observed pain behaviors.
Main Methods:
- A prospective control group study involving 120 children aged 6-12 years.
- Utilized block-randomization and validated scales (Face-Pain-Scale-Revised, Faces-Legs-Activity-Cry-Consolability Scale) for assessment.
- Employed multivariate covariance analysis for statistical evaluation.
Main Results:
- The picture book significantly reduced pre-procedural pain expectation (p=0.001, ES=0.56), even after controlling for baseline expectations.
- Children not receiving local anesthesia reported less pain after using the picture book.
- No significant benefit was observed in the small group that received local anesthesia.
Conclusions:
- The picture book is a recommended intervention for reducing pain expectation in children undergoing blood draws.
- Its utility is particularly noted when local anesthesia cannot be effectively administered.
- Suggests a practical, non-pharmacological approach to managing pediatric procedural pain.
Objectives:
Blood drawings are very painful and stressful for children. In a prospective control group study we investigated if using a picture book could reduce the children's pain expectation. In addition, the children's pain experience and the observed pain behaviour was monitored.
Patients/Methods:
Block-randomization were used and 120 children at the age of 6-12 years who were visiting the general pediatric and coagulation outpatient clinics were included in this study. Pain expectation and experience were assessed with the Face-Pain-Scale-Revised and the pain behavior with the Faces-Legs-Activity-Cry-Consolability Scale. Multivariate covariance analysis was used for data analysis.
Results:
The results showed that with statistical controlling the influence of the primary pain expectation (baseline) the pain expectation before blood withdrawal was reduced significantly (p=0.001) and effectively (ES=0.56) using the picture book. Children who received no local anaesthesia reported that they felt less pain during blood drawing after reading the picture book. The few children with local anaesthesia reported no benefit from the picture book. The observed use of local anaesthesia was very heterogeneous.
Conclusions:
The results recommend the usage of this picture book in everyday practice, if the use of local anaesthesia could not be used in an appropriate way.
