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Pain and distress outcomes in infants and children: a systematic review
N C A C Oliveira1, C M Gaspardo1, M B M Linhares1
1Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
Insights
This review of pediatric pain research found that while interventions like distraction can reduce pain and distress, the link between these two outcomes is often not well-analyzed in studies.
Area of Science:
- Pediatric Psychology
- Pain Management
- Evidence-Based Practice
Background:
- Pain and distress are significant concerns in pediatric populations.
- Recent literature on pediatric pain and distress outcomes requires systematic evaluation.
- Methodological quality and psychometric properties of pain instruments need critical assessment.
Purpose of the Study:
- To systematically review recent literature on pain and distress in children.
- To critically analyze the methodological quality of included studies.
- To evaluate the psychometric quality of pain assessment instruments.
Main Methods:
- Systematic literature review adhering to the PRISMA statement.
- Methodological quality assessed using STROBE and CONSORT statements.
- Psychometric quality evaluated using the PedIMMPACT consensus.
Main Results:
- Analyzed 23 empirical studies (14 RCTs, 7 cross-sectional, 2 cohort).
- Interventions like distraction and healing touch showed efficacy in reducing pain and distress.
- All studies met a minimum methodological quality threshold; pain measures were well-established.
Conclusions:
- Evidence supports interventions for reducing pediatric pain and distress.
- Pain and distress are often measured as distinct constructs.
- The association between pain and distress requires further investigation in pediatric research.
Abstract:
The aim of the present study was to systematically review the recent literature about pain and distress outcomes in children and critically analyze the methodological quality of the reports. The systematic review was based on the PRISMA statement and performed by selecting articles that are indexed in scientific databases. The methodological quality of reports was examined using STROBE statement, for observational studies, and CONSORT statement, for randomized controlled trials. The PedIMMPACT consensus was used to evaluate the psychometric quality of pain instruments. We analyzed 23 empirical studies, including 14 randomized controlled trials, seven cross-sectional studies, and two studies with cohort designs. Fourteen studies included preschool- and schoolchildren, and nine studies included infants. Regarding studies with infants, pain responses were evaluated by heart rate, crying and behavioral observation scales, and distress was evaluated only by salivary cortisol. Four-handed care and sensorial saturation interventions were used to evaluate efficacy to reduce pain and distress responses. Concerning studies with children, both pain and distress responses were evaluated by self- and hetero-reports, behavioral observation and/or physiological measures. Distraction was effective for reducing pain and distress during burn dressing changes and needle procedures, and healing touch intervention reduced distress and pain in chronic patients. All of the studies scored at least 60% in the methodological quality assessment. The pain outcomes included measures of validity that were classified as well-established by the PedIMMPACT. This systematic review gathers scientific evidence of distress-associated pain in children. Pain and distress were measured as distinct constructs, and their associations were poorly analyzed.
