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Updated: Apr 21, 2026
Electrophysiological Measurements and Analysis of Nociception in Human Infants
Published on: December 20, 2011
Perception of venipuncture pain in children suffering from chronic diseases
Sofia Bisogni, Chiara Dini, Nicole Olivini
1Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy. filippo.festini@unifi.it.
Insights
Children with chronic diseases experience significantly more pain and distress during venipuncture than healthy children. Repeated painful procedures do not increase pain tolerance in these children.
Area of Science:
- Pediatric Pain Management
- Child Psychology
- Clinical Nursing
Background:
- Venipuncture pain in children is influenced by factors like anticipatory anxiety.
- Children with chronic diseases frequently undergo venipuncture, leading to repeated painful stimuli.
- A common misconception suggests repeated pain exposure increases pain tolerance in children with chronic diseases.
Purpose of the Study:
- To investigate differences in venipuncture pain perception between children with and without chronic diseases.
- To determine if children with chronic diseases have a different pain threshold compared to healthy children.
Main Methods:
- A cross-sectional study involving 230 children aged 4-12 years.
- Utilized Wong and numeric pain scales and the Observational Scale of Behavioral Distress (OSBD).
- Compared pain and behavioral distress during a standardized venipuncture procedure between two groups.
Main Results:
- Children with chronic diseases (n=82) reported higher pain (median 8) and distress (median 27 OSBD) than those without (n=148, median 2 pain, median 5 OSBD).
- Statistical analysis showed significant differences in pain and distress scores (p=0.00001 for both).
Conclusions:
- Children with chronic diseases exhibit a lower pain threshold compared to age- and sex-matched children experiencing venipuncture for the first time.
- Findings challenge the belief that repeated painful procedures lead to increased pain tolerance in pediatric patients.
Background:
Venipuncture pain in children results from a variety of co-factors which increase the intensity of the nociceptive stimulus. Among them, anticipatory anxiety plays an important role. Children with chronic diseases undergo invasive procedures and venipuncture more often than other children. Some healthcare professionals still believe that children who are repeatedly exposed to painful procedures, such as children with chronic diseases, gradually increase their pain tolerance and that, as a result, they have a higher pain threshold than children with no chronic diseases. The purpose of this study was to assess whether a difference exists in the perception of venipuncture pain between children with chronic diseases and children with no previous health problems nor experience of venipuncture.
Methods:
A cross-sectional study was carried out using the Wong and numeric pain scales and the Observational Scale of Behavioral Distress (OSBD) for the assessment of behavioral distress. A group of children with chronic diseases and a group of children with no previous health problems nor experience of venipuncture, aged 4 to 12 years, both boys and girls, were observed during a standardized venipuncture procedure.
Results:
The study included 230 children in total: 82 of them suffered from chronic diseases and had already experienced venipuncture at least once, while the remaining 148 children had no previous experience of venipuncture. The children with chronic diseases reported more pain (median pain score of 8 on the Wong or numeric scales,) and showed more signs of behavioral distress (median score of 27 on the OSBD) than non-chronic children (median pain score of 2 on the Wong/numeric scales, p = 0.00001; median OSBD score 5, p = 0.00001).
Conclusions:
Our study suggests that children with chronic diseases have a lower pain threshold than children of the same sex and age who experience venipuncture for the first time.
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