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Singleton H, Mahato P, Arden-Close E, Thomas S, Ersser S, Holley D, Yang X, Roberts A. Virtual reality used to distract children and young people with long-term conditions from pain or pruritus: A scoping review using PAGER. J Clin Nurs 2024; 33:469-480. [PMID: 37962251 DOI: 10.1111/jocn.16928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/13/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023]
Abstract
AIMS AND OBJECTIVES To map out the primary research studies relating to how virtual reality (VR) has been used to distract children and young people with long-term conditions from pain or pruritus. BACKGROUND Pharmacologic treatment of chronic pain and pruritus may have side effects; hence, non-invasive non-pharmacological treatments are being sought. DESIGN The scoping review followed the methodology recommended by the Joanna Briggs Institute, PAGER framework and PRISMA-ScR checklist. The protocol was registered with the Open Science Registration on 14 February 2022 https//doi.org/10.17605/OSF.IO/K2R93. METHODS Five databases (Medline, CINAHL, PsycINFO, Web of Science and Scopus) were searched. Data were extracted from primary research studies published between 2000 and 2022 involving children and adolescent populations (<21 years) with a long-term condition that had an element of enduring pruritus and/or pain. RESULTS Of 464 abstracts screened, 35 full-text papers were assessed with 5 studies meeting the eligibility criteria. Three main themes emerged from the included studies: (1) Improvements in pain and daily functioning; (2) positive perceptions of VR and (3) accessibility and feasibility of VR. No papers were found on the effect of VR on alleviating pruritus. CONCLUSION VR is feasible, acceptable, and safe for children and adolescents with chronic pain in a range of long-term conditions and offers promise as an adjunctive treatment for improving chronic pain and quality of life. No studies were identified that targeted pruritis or measured pruritis outcomes; thus, the effects of VR for pruritis are unknown. There is a need for rigorously designed, randomised controlled trials to test the clinical and cost-effectiveness of VR interventions for chronic pain and pruritis in children and adolescents. The use of the PAGER (Patterns, Advances, Gaps, Evidence for Practice and Research Recommendations) framework for scoping reviews helped to structure analysis and findings and identify research gaps. RELEVANCE TO CLINICAL PRACTICE VR interventions offer promise in improving chronic pain related to long-term conditions.
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Affiliation(s)
| | | | | | | | | | | | | | - Amanda Roberts
- Nottingham Support for Carers of Children with Eczema, Nottingham, UK
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Shen T, Wang X, Xue Q, Chen D. Active versus passive distraction for reducing procedural pain and anxiety in children: a meta-analysis and systematic review. Ital J Pediatr 2023; 49:109. [PMID: 37653423 PMCID: PMC10472688 DOI: 10.1186/s13052-023-01518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Procedural pain is very important in clinical children care. We aimed to evaluate the effects of active versus passive distraction for reducing procedural pain and anxiety in children. METHODS Two researchers searched the Web of Science, PubMed, EMBASE, Cochrane, SinoMed, Wanfang, China National Knowledge Infrastructure, Weipu databases for the randomized controlled trials(RCTs) on the active versus passive distraction affecting procedural pain and anxiety in children until May 18, 2023. The literature screening and data extraction were carried out by two researchers independently. Review Manager 5.3 software was used for data analysis. RESULTS 13 RCTs were finally included. 553 children received active distraction intervention and 551 children received passive distraction intervention. There were no significant differences in the children self-reported procedural pain betweent active and passive distraction. The parent-reported procedural pain, medical staff-reported procedural pain, children-reported procedural anxiety, parent-reported procedural anxiety, medical staff-reported procedural anxiety in the active distraction were significant less than that of active distraction. Egger regression analysis showed that there was no publication bias in the results. CONCLUSIONS Existing evidence suggests that active distraction may be more effective in reducing operational pain and anxiety in children than passive distraction. More studies on the effects of active distraction versus passive distraction in children with larger sample size are needed in the future.
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Affiliation(s)
- Ting Shen
- Department of Emergency, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Xixi Wang
- Department of Emergency, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Qiaoyun Xue
- Department of Emergency, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Dan Chen
- Department of Emergency, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China.
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Balliel N. Effect of soap bubbles technique, coughing and distraction cards on reducing pain and anxiety during phlebotomy in children. PAEDIATRIC & NEONATAL PAIN 2023; 5:31-37. [PMID: 37283955 PMCID: PMC10240404 DOI: 10.1002/pne2.12090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 06/08/2023]
Abstract
This study aims to compare three techniques (soap bubbles, distraction cards, coughing) to reduce pain and anxiety in children during phlebotomy and collection with the use of a control group. Pain levels of children were assessed with the Wong-Baker FACES Pain Rating Scale and anxiety levels of children were assessed with the Children's Fear Scale. This randomized controlled study involved intervention groups and a control group. The population of this study consisted of 120 Turkish children (30 subjects in each of the four groups soap bubbles technique, distraction cards, coughing, and control groups) between the ages of 6 and 12. The study found that pain and anxiety levels of the children in intervention groups were lower than those of the children in the control group during phlebotomy procedure and this difference was statistically significant (P < .05). No difference was found among the three techniques (Soap bubbles, distraction cards, and coughing) to reduce pain and anxiety in children during the phlebotomy procedure (P > .05). Soap bubbles, distraction cards and coughing techniques were found to reduce pain and anxiety in children during phlebotomy. Nurses can play an effective role in reducing pain and anxiety by using these techniques.
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Affiliation(s)
- Nükhet Balliel
- Public Health Nursing Department, Nursing FacultyAydın Adnan Menderes UniversityAydınTurkey
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Virtual reality-based distraction on pain, performance, and anxiety during and after moderate-vigorous intensity cycling. Physiol Behav 2022; 250:113779. [PMID: 35283175 DOI: 10.1016/j.physbeh.2022.113779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine whether increased visual perceptual load (PL) within an immersive virtual environment may help explain previously shown pain-relieving effects of virtual reality (VR) during high intensity cycling. METHODS Using a within-subjects design, participants cycled at a perceptually "hard" intensity for 10 min on three separate occasions. The first session did not use VR (i.e., no perceptual load - NPL). Subsequent sessions employed VR during cycling with either a low or high perceptual load (LPL or HPL). Quadriceps pain intensity (PI) was reported by participants throughout cycling. RESULTS Data were analyzed for 43 healthy participants (20 females, mean age 21 [SD 1.4]). For PI, ANOVA showed there were significant main effects of condition (F = 13.458, df =1.579, 66.334, p<0.001) and time (F = 113.045, df =1.618, 227.683, p<0.001). At every time point, t-tests revealed mean PI was significantly lower in the NPL than in the LPL condition (t(42)=4.737, p<0.001, d = 0.472) and HPL condition (t(42)=3.380, p = 0.002, d = 0.391). Dependent t-tests showed that more work (kilojoules) was performed during the LPL condition than the NPL (t(42)=2.992, p = 0.005) and HPL (t(42)=5.810, p<0.001) conditions. CONCLUSIONS Compared to a traditional 10-minute bout of cycle ergometry (NPL), individuals who cycled in the LPL condition chose to exercise at a higher intensity despite greater PI. Those who cycled in the HPL condition did not change their exercise intensity, but did report higher PI, possibly, because of the greater mental effort/energy requirement.
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Triage through telemedicine in paediatric emergency care—Results of a concordance study. PLoS One 2022; 17:e0269058. [PMID: 35617339 PMCID: PMC9135216 DOI: 10.1371/journal.pone.0269058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background In the German health care system, parents with an acutely ill child can visit an emergency room (ER) 24 hours a day, seven days a week. At the ER, the patient receives a medical consultation. Many parents use these facilities as they do not know how urgently their child requires medical attention. In recent years, paediatric departments in smaller hospitals have been closed, particularly in rural regions. As a result of this, the distances that patients must travel to paediatric care facilities in these regions are increasing, causing more children to visit an ER for adults. However, paediatric expertise is often required in order to assess how quickly the patient requires treatment and select an adequate treatment. This decision is made by a doctor in German ERs. We have examined whether remote paediatricians can perform a standardised urgency assessment (triage) using a video conferencing system. Methods Only acutely ill patients who were brought to a paediatric emergency room (paedER) by their parents or carers, without prior medical consultation, have been included in this study. First, an on-site paediatrician assessed the urgency of each case using a standardised triage. In order to do this, the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) was translated into German and adapted for use in a standardised IT-based data collection tool. After the initial on-site triage, a telemedicine paediatrician, based in a different hospital, repeated the triage using a video conferencing system. Both paediatricians used the same triage procedure. The primary outcome was the degree of concordance and interobserver agreement, measured using Cohen’s kappa, between the two paediatricians. We have also included patient and assessor demographics. Results A total of 266 patients were included in the study. Of these, 227 cases were eligible for the concordance analysis. In n = 154 cases (68%), there was concordance between the on-site paediatrician’s and telemedicine paediatrician’s urgency assessments. In n = 50 cases (22%), the telemedicine paediatrician rated the urgency of the patient’s condition higher (overtriage); in 23 cases (10%), the assessment indicated a lower urgency (undertriage). Nineteen medical doctors were included in the study, mostly trained paediatric specialists. Some of them acted as an on-site doctor and telemedicine doctor. Cohen’s weighted kappa was 0.64 (95% CI: 0.49–0.79), indicating a substantial agreement between the specialists. Conclusions Telemedical triage can assist in providing acute paediatric care in regions with a low density of paediatric care facilities. The next steps are further developing the triage tool and implementing telemedicine urgency assessment in a larger network of hospitals in order to improve the integration of telemedicine into hospitals’ organisational processes. The processes should include intensive training for the doctors involved in telemedical triage. Trial registration DRKS00013207.
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Hoag JA, Karst J, Bingen K, Palou-Torres A, Yan K. Distracting Through Procedural Pain and Distress Using Virtual Reality and Guided Imagery in Pediatric, Adolescent, and Young Adult Patients: Randomized Controlled Trial. J Med Internet Res 2022; 24:e30260. [PMID: 35436209 PMCID: PMC9062714 DOI: 10.2196/30260] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/06/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Children with acute and chronic illness undergo frequent, painful, and distressing procedures. OBJECTIVE This randomized controlled trial was used to evaluate the effectiveness of guided imagery (GI) versus virtual reality (VR) on the procedural pain and state anxiety of children and young adults undergoing unsedated procedures. We explored the role of trait anxiety and pain catastrophizing in intervention response. METHODS Children and young adults were recruited from the hematology, oncology, and blood and marrow transplant clinics at a children's hospital. Each study participant completed the GI and VR intervention during separate but consecutive unsedated procedures. Self-report measures of pain and anxiety were completed before and after the procedures. RESULTS A total of 50 participants (median age 13 years) completed both interventions. GI and VR performed similarly in the management of procedural pain. Those with high pain catastrophizing reported experiencing less nervousness about pain during procedures that used VR than those using GI. State anxiety declined pre- to postprocedure in both interventions; however, the decrease reached the level of significance during the VR intervention only. Those with high trait anxiety had less pain during GI. CONCLUSIONS In our sample, VR worked as well as GI to manage the pain and distress associated with common procedures experienced by children with acute or chronic illnesses. Children who are primed for pain based on beliefs about pain or because of their history of chronic pain had a better response to VR. GI was a better intervention for those with high trait anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT04892160; https://clinicaltrials.gov/ct2/show/NCT04892160.
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Affiliation(s)
- Jennifer A Hoag
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jeffrey Karst
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kristin Bingen
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Akasha Palou-Torres
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ke Yan
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
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Menekli T, Yaprak B, Doğan R. The Effect of Virtual Reality Distraction Intervention on Pain, Anxiety, and Vital Signs of Oncology Patients Undergoing Port Catheter Implantation: A Randomized Controlled Study. Pain Manag Nurs 2022; 23:585-590. [PMID: 35367144 DOI: 10.1016/j.pmn.2022.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/09/2022] [Accepted: 03/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although the port catheters have many beneficial effects on the patient's quality of life, it was reported in the literature that patients experience pain in the incision area after the implantation or anxiety before, during or, after the implantation.Distraction is a simple and effective method in the management of pain and anxiety. AIMS To determine the effect of virtual reality (VR) distraction intervention on pain, anxiety, and vital signs of oncology patients undergoing port catheter implantation. DESIGN Randomized controlled study METHODS: The study was carried out with 139 participants (69 intervention, 70 control) between September 2019 and January 2020. Data were collected before, during, and after the implantation by using a patient identification form, State Anxiety Inventory (SAI), a table for vital signs, and a visual analog scale for pain severity. In the intervention group, a virtual reality device, movies, and relaxing music were provided and patients were instructed to use it during the implantation and when they felt pain after the implantation. There wasn't any blinding for patients or researchers throughout the study. RESULTS There was an increase in pain scores of both groups after the implantation; however, pain scores in the intervention group were lower and there was a statistically significant difference between the groups after the implantation. In the intervention group, there was a decrease in anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate, and an increase in SpO2. VR use has a great effect on pain scores (Cohen's d = 3.023) and a great effect on SAI scores (Cohen's d = 8.770). CONCLUSIONS VR distraction intervention was found an effective way to reduce pain, anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate and increase the SpO2 of the patients undergoing port catheter implantation.
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Affiliation(s)
- Tuğba Menekli
- Department of Internal Medicine Nursing, Malatya Turgut Özal University, Malatya, Turkey.
| | - Bülent Yaprak
- Internal Medicine Department, Malatya Turgut Özal University, Malatya, Turkey
| | - Runida Doğan
- Department of Surgical Nursing, Inonu University, Malatya, Turkey
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Saquib J, AlMohaimeed HA, AlOlayan SA, AlRebdi NA, AlBulaihi JI, AlMugbel RA, AlDughaishm YM, AlBahli HK, Saquib N. Effect of interactive vs. passive virtual reality on pain threshold and tolerance. Scand J Pain 2022; 22:167-172. [PMID: 34348422 DOI: 10.1515/sjpain-2021-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Scientific evidence suggests that virtual reality (VR) could potentially help patients tolerate painful medical procedures and conditions. The aim of this study was to evaluate the efficacy of virtual reality on pain tolerance and threshold. METHODS A within-subjects experimental study design was conducted on 53 female students at Qassim University in Saudi Arabia. Each participant completed three rounds of assessment: one baseline (no VR) and two VR immersion (passive and interactive) in random order sequence. During each round, participants submerged their non-dominant hand into an ice bath; pain threshold and tolerance were measured as outcomes and analyzed using repeated measures ANOVA. RESULTS Participants had both higher pain threshold and tolerance during interactive and passive VR rounds in comparison to the non-VR baseline assessment (p<0.05). Participants had greater pain tolerance during the interactive VR condition compared to the passive VR condition (p<0.001). CONCLUSIONS VR experiences increase pain threshold and tolerance with minimal side effects, and the larger effects were demonstrated using interactive games. Interactive VR gaming should be considered and tested as a treatment for pain.
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Affiliation(s)
- Juliann Saquib
- College of Medicine, Sulaiman Al Rajhi University, Bukayriyah, Saudi Arabia
| | | | | | - Nora A AlRebdi
- College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | | | | | | | - Hind K AlBahli
- College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Nazmus Saquib
- College of Medicine, Sulaiman Al Rajhi University, Bukayriyah, Saudi Arabia
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Li L, Ma J, Ma D, Zhou X. Smartphone Interventions Effect in Pediatric Subjects on the Day of Surgery: A Meta-Analysis. Front Surg 2022; 8:759958. [PMID: 34977139 PMCID: PMC8716411 DOI: 10.3389/fsurg.2021.759958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: A meta-analysis was performed to evaluate the effect of smartphone interventions on the anxiety of the pediatric subjects at induction on the day of surgery compared to oral midazolam or standard care as control. Methods: A systematic literature search up to June 2021 was performed and nine studies selected 785 pediatric subjects on the day of surgery at the start of the study; 390 of them were using smartphone interventions, 192 were control, and 203 were using oral midazolam. They were reporting relationships between the effects of smartphone interventions on the anxiety of the pediatric subjects at induction on the day of surgery compared to oral midazolam or control. The mean difference (MD) with its 95% CIs was calculated to assess the effect of smartphone interventions on the anxiety of the pediatric subjects at induction on the day of surgery compared to oral midazolam or control using the continuous method with a fixed or a random-effects model. Results: Smartphone interventions in pediatric subjects were significantly related to lower anxiety at induction on the day of surgery (MD, -19.74; 95% CI, -29.87 to -9.61, p < 0.001) compared to control and significantly related to lower anxiety at induction on the day of surgery (MD, -7.81; 95% CI, -14.49 to -1.14, p = 0.02) compared to oral midazolam. Conclusion: Smartphone interventions in pediatric subjects on the day of surgery may have lower anxiety at induction compared to control and oral midazolam. Further studies are needed to confirm these findings.
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Affiliation(s)
- Li Li
- Department of Pediatrics, Hebei Children's Hospital, Shijiazhuang, China
| | - Jianping Ma
- Department of Pediatric Orthopedics, Hebei Children's Hospital, Shijiazhuang, China
| | - Dan Ma
- Operating Room, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Xiaokang Zhou
- Department of Pediatric Orthopedics, Hebei Children's Hospital, Shijiazhuang, China
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Aklilu T, Ibrahim M. Knowledge, attitude, and experiences of using penicillin G, as a prophylaxis for rheumatic fever and rheumatic heart diseases among nurses in Addis Ababa, Ethiopia: A cross-sectional survey. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_30_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nelson S, Agoston M, Kovar-Gough I, Cunningham N. A Scoping Review and Proposed Framework for Coping in Youth With a History of Psychological Trauma and Chronic Pain. J Pediatr Psychol 2021; 47:469-482. [PMID: 34939115 DOI: 10.1093/jpepsy/jsab127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Psychological trauma (e.g., abuse, neglect) and posttraumatic stress symptoms (PTSS) commonly occur in pediatric pain populations and may be related to various maladaptive coping strategies, which may in turn affect short- and long-term pain-related outcomes in youth. Accordingly, the current scoping review and conceptual framework seeks to identify important gaps in the field's current understanding of how coping impacts outcomes in youth who have experienced trauma/PTSS and pediatric chronic pain and explores avenues for future investigation. METHODS A scoping review of the literature was performed in Medline, Embase, Cochrane Library, PsycInfo, and Sociological Abstracts. Eligibility criteria included pediatric populations experiencing chronic pain, trauma, adverse childhood events, and/or PTSS and associated coping mechanisms. Nine research papers were selected and used to support the conceptual framework. The framework builds upon the work of Compas et al.'s' model of control-based coping (Compas et al., 2006; Compas & Harding Thomsen, 1999) and outlines the potential effects of trauma and/or PTSS and pain on coping and pain-related outcomes (e.g., pain chronicity, functional outcomes) in pediatric chronic pain populations. RESULTS A history of chronic pain and psychological trauma and/or PTSS in youth may contribute to increased risk for maladaptive coping and in turn, poorer pain-related and psychosocial outcomes long-term. CONCLUSIONS Findings from the current scoping review and proposed conceptual framework will guide future research and treatment efforts for youths experiencing pain and trauma and/or PTSS and thereby enhance long-term outcomes.
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Affiliation(s)
- Sarah Nelson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, USA.,Department of Psychiatry, Harvard Medical School, USA
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Fairclough SH, Dobbins C, Stamp K. Classification of Game Demand and the Presence of Experimental Pain Using Functional Near-Infrared Spectroscopy. FRONTIERS IN NEUROERGONOMICS 2021; 2:695309. [PMID: 38235227 PMCID: PMC10790923 DOI: 10.3389/fnrgo.2021.695309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/02/2021] [Indexed: 01/19/2024]
Abstract
Pain tolerance can be increased by the introduction of an active distraction, such as a computer game. This effect has been found to be moderated by game demand, i.e., increased game demand = higher pain tolerance. A study was performed to classify the level of game demand and the presence of pain using implicit measures from functional Near-InfraRed Spectroscopy (fNIRS) and heart rate features from an electrocardiogram (ECG). Twenty participants played a racing game that was configured to induce low (Easy) or high (Hard) levels of demand. Both Easy and Hard levels of game demand were played with or without the presence of experimental pain using the cold pressor test protocol. Eight channels of fNIRS data were recorded from a montage of frontal and central-parietal sites located on the midline. Features were generated from these data, a subset of which were selected for classification using the RELIEFF method. Classifiers for game demand (Easy vs. Hard) and pain (pain vs. no-pain) were developed using five methods: Support Vector Machine (SVM), k-Nearest Neighbour (kNN), Naive Bayes (NB) and Random Forest (RF). These models were validated using a ten fold cross-validation procedure. The SVM approach using features derived from fNIRS was the only method that classified game demand at higher than chance levels (accuracy = 0.66, F1 = 0.68). It was not possible to classify pain vs. no-pain at higher than chance level. The results demonstrate the viability of utilising fNIRS data to classify levels of game demand and the difficulty of classifying pain when another task is present.
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Affiliation(s)
| | - Chelsea Dobbins
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD, Australia
| | - Kellyann Stamp
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
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Su HC, Hsieh CW, Lai NM, Chou PY, Lin PH, Chen KH. Using Vibrating and Cold Device for Pain Relieves in Children: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Pediatr Nurs 2021; 61:23-33. [PMID: 33735633 DOI: 10.1016/j.pedn.2021.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Needle procedures are the most common source of pain, anxiety, and fear among children. A combination of a cooling ice-pack and/or a vibrating motor for pain management in children has been evaluated in trials, but their overall effects await a synthesis of the available evidence. METHOD Comprehensive search was conducted using Cochrane, PubMed, EMBASE, PsycINFO, CINAHL and Airiti. We calculated pooled risk ratios (RR), mean difference (MD) and 95% CI using RevMan 5.3. A meta-regression was conducted to investigate the effects of mean age on MD of pain. RESULTS A total of 1479 children from 16 publications were included. Compared with the control group, using cold-vibrating device significantly decreased pain level above the age of 2 (MD -3.03, 95% CI: -3.38, -2.68), as well as lower anxiety level among parents (MD -1.3, 95% CI: -1.9, -0.7). Meta-regression demonstrated a significant negative correlation of pain score with age. For children at 8.5 years, cold-vibration reduced the pain score by 0.13 averagely for every increment in year compared with controls (MD -0.13; 95% CI: -0.25, -0.01). No adverse events were reported in included studies. DISCUSSION The cold-vibrating device reduced pain levels significantly among children without adverse effects. Variation of factors might contribute to the heterogeneity of our study, such as age, different needle procedures, psychological strategies…etc. CONCLUSIONS Cool-vibration treatment reduced pain levels in children who underwent needle procedures and the treatment appears more effective in older children. The device is promising in clinical setting due to its non-invasiveness and ease of usage.
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Affiliation(s)
- Hui-Chuan Su
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Chia-Wen Hsieh
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Nai Ming Lai
- School of Medicine, Taylor's University, Malaysia; School of Pharmacy, Monash University, Malaysia
| | - Pao-Yu Chou
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Pu-Hung Lin
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Kee-Hsin Chen
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taiwan; Cochrane Taiwan, Taipei Medical University, Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taiwan; Evidence-Based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taiwan.
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The effect of playing games with toys made with medical materials in children with cancer on pain during intravenous treatment. Palliat Support Care 2021; 20:84-93. [PMID: 33947501 DOI: 10.1017/s1478951521000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This research aims to examine the effect of playing games with toys made of medical materials in children with cancer on pain that occurs during intravenous (IV) treatment. METHODS The randomized controlled clinical trial was conducted between May 2016 and February 2018. The study sample comprised 110 children (experimental group 55; control group 55), determined using power analysis from the study population. The data were collected by the researcher, using face-to-face interview techniques, the Information Form, and Wong-Baker FACES Pain Rating Scale (WBS). RESULTS The pre- and post-test pain mean scores of patients in the experimental group were 2.27 ± 0.91 and 0.43 ± 0.66, respectively (p = 0.0001). The pre- and post-test pain mean scores of patients in the control group were 1.72 ± 0.82 and 3.34 ± 0.77, respectively (p = 0.0001). SIGNIFICANCE OF RESULTS The experience of playing with toys made from materials used for invasive procedures relieves pain the during IV treatment.
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15
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Erdim L. The effect on pain and anxiety levels of using DistrACTION® Cards to distract children during a skin-prick test: a randomized controlled experimental study. Minerva Pediatr (Torino) 2021; 74:167-175. [PMID: 33820412 DOI: 10.23736/s2724-5276.21.06008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The effect of using Distraction® Cards to distract children aged 6-10 during a skin-prick test on their levels of pain and anxiety was explored in this study. METHODS The study was conducted as randomized, controlled, experimental research with a total of 104 children presenting at a hospital for a skin-prick test, 52 of whom comprised the experimental and 52 the control group. DistrACTION® Cards were employed in the experimental group of children to distract their attention during a skin prick test by observer nurse. The observer nurse asked each child to look at the pictures on the cards and answer her questions. The pictures on the cards portray various details. The children's pain and anxiety levels were independently assessed on the basis of the feedback provided by the children, the observer nurse and the parents. The children's pain levels were assessed with the Wong-Baker Pain Scale (W-BPS) and their anxiety levels with the Children's Fear Scale (CFS). No intervention was carried out for the children in the control group. RESULTS It was found that the children's pain scores during (D:0.57±1.14; C:3.15±3.07) and after the procedure (D:0.05±0.23; C:2.32±3.42) were significantly lower than those of the control group. It was seen that the anxiety scores of the experimental group during (D: 0.63±0.97; C:2.69±1.26) and after the procedure (D:0.11±0.37; C:1.82±1.53) were significantly lower than those of the control group. CONCLUSIONS It was observed that the use of DistrACTION® Cards during a skin prick test was effective in reducing children's pain and anxiety levels.
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Affiliation(s)
- Leyla Erdim
- Midwifery Department, Istanbul University-Cerrahpasa Faculty of Health Sciences, İstanbul, Turkey -
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16
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Daniela A, Ciceri MR. Encephalon Mri in 4-12 Years Old Children: How Pain, Fear and Sadness Regulation Affect MRI Image Quality. PSYCHOL HEALTH MED 2021; 27:537-545. [PMID: 33449830 DOI: 10.1080/13548506.2021.1874431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Magnetic Resonance Imaging is often difficult to conduct, especially in children, because of restricted space, forced immobility, and loud noises. Providing children with adequate and age-appropriate information about the procedurecould reduce the use of anesthesia, the time and cost necessary . This research investigated the emotional regulation skills of children when provided with an information and orientation task before the examination. Analogical scales were used to measure the levels of fear, pleasure, and pain felt by 60 children who were waiting for a brain magnetic Resonance in two hospitals in Milan . Data collection took place at three different junctures; upon children's arrival at the hospital, following their preparation for this experience, and after the examination. Results showed that preparing children for the procedure helped to reduce anxiety and provided a space for them to externalize and self-regulate their emotional experiences. To combine the information strategy with the lived experiences allows the patient to anticipate the examination and to experience it in a simulation context, thus coming to the real examination more prepared and less emotionally activated. Preparation has a positive effect on children of all ages, particularly 4- to 7-year-old's. Moreover, fear regulation is associated with improved Magnetic resonance quality.
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Affiliation(s)
- Abati Daniela
- Department of Psychology, Università Cattolica Del Sacro Cuore, Milan, Italy
| | - Maria Rita Ciceri
- Department of Psychology, Università Cattolica Del Sacro Cuore, Milan, Italy
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Lambert V, Boylan P, Boran L, Hicks P, Kirubakaran R, Devane D, Matthews A. Virtual reality distraction for acute pain in children. Cochrane Database Syst Rev 2020; 10:CD010686. [PMID: 33089901 PMCID: PMC8094164 DOI: 10.1002/14651858.cd010686.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Virtual reality (VR) computer technology creates a simulated environment, perceived as comparable to the real world, with which users can actively interact. The effectiveness of VR distraction on acute pain intensity in children is uncertain. OBJECTIVES To assess the effectiveness and adverse effects of virtual reality (VR) distraction interventions for children (0 to 18 years) with acute pain in any healthcare setting. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and four trial registries to October 2019. We also searched reference lists of eligible studies, handsearched relevant journals and contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs), including cross-over and cluster-RCTs, comparing VR distraction to no distraction, non-VR distraction or other VR distraction. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological processes. Two reviewers assessed risk of bias and extracted data independently. The primary outcome was acute pain intensity (during procedure, and up to one hour post-procedure). Secondary outcomes were adverse effects, child satisfaction with VR, pain-related distress, parent anxiety, rescue analgesia and cost. We used GRADE and created 'Summary of findings' tables. MAIN RESULTS We included 17 RCTs (1008 participants aged four to 18 years) undergoing various procedures in healthcare settings. We did not pool data because the heterogeneity in population (i.e. diverse ages and developmental stages of children and their different perceptions and reactions to pain) and variations in procedural conditions (e.g. phlebotomy, burn wound dressings, physical therapy sessions), and consequent level of pain experienced, made statistical pooling of data impossible. We narratively describe results. We judged most studies to be at unclear risk of selection bias, high risk of performance and detection bias, and high risk of bias for small sample sizes. Across all comparisons and outcomes, we downgraded the certainty of evidence to low or very low due to serious study limitations and serious or very serious indirectness. We also downgraded some of the evidence for very serious imprecision. 1: VR distraction versus no distraction Acute pain intensity: during procedure Self-report: one study (42 participants) found no beneficial effect of non-immersive VR (very low-certainty evidence). Observer-report: no data. Behavioural measurements (observer-report): two studies, 62 participants; low-certainty evidence. One study (n = 42) found no beneficial effect of non-immersive VR. One study (n = 20) found a beneficial effect favouring immersive VR. Acute pain intensity: post-procedure Self-report: 10 studies, 461 participants; very low-certainty evidence. Four studies (n = 95) found no beneficial effect of immersive and semi-immersive or non-immersive VR. Five studies (n = 357) found a beneficial effect favouring immersive VR. Another study (n = 9) reported less pain in the VR group. Observer-report: two studies (216 participants; low-certainty evidence) found a beneficial effect of immersive VR, as reported by primary caregiver/parents or nurses. One study (n = 80) found a beneficial effect of immersive VR, as reported by researchers. Behavioural measurements (observer-report): one study (42 participants) found no beneficial effect of non-immersive VR (very low-certainty evidence). Adverse effects: five studies, 154 participants; very low-certainty evidence. Three studies (n = 53) reported no adverse effects. Two studies (n = 101) reported mild adverse effects (e.g. nausea) in the VR group. 2: VR distraction versus other non-VR distraction Acute pain intensity: during procedure Self-report, observer-report and behavioural measurements (observer-report): two studies, 106 participants: Self-report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (very low-certainty evidence). Observer-report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (low-certainty evidence). Behavioural measurements (observer-report): one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) reported a difference in mean pain change scores with fewer pain behaviours in VR group (low-certainty evidence). Acute pain intensity: post-procedure Self-report: eight studies, 575 participants; very low-certainty evidence. Two studies (n = 146) found a beneficial effect favouring immersive VR. Two studies (n = 252) reported a between-group difference favouring immersive VR. One study (n = 59) found no beneficial effect of immersive VR versus television and Child Life non-VR distraction. One study (n = 18) found no beneficial effect of semi-immersive VR. Two studies (n = 100) reported no between-group difference. Observer-report: three studies, 187 participants; low-certainty evidence. One study (n = 81) found a beneficial effect favouring immersive VR for parent, nurse and researcher reports. One study (n = 65) found a beneficial effect favouring immersive VR for caregiver reports. Another study (n = 41) reported no evidence of a difference in mean pain change scores. Behavioural measurements (observer-report): two studies, 106 participants; low-certainty evidence. One study (n = 65) found a beneficial effect favouring immersive VR. Another study (n = 41) reported no evidence of a difference in mean pain change scores. Adverse effects: six studies, 429 participants; very low-certainty evidence. Three studies (n = 229) found no evidence of a difference between groups. Two studies (n = 141) reported no adverse effects in VR group. One study (n = 59) reported no beneficial effect in reducing estimated cyber-sickness before and after VR immersion. 3: VR distraction versus other VR distraction We did not identify any studies for this comparison. AUTHORS' CONCLUSIONS We found low-certainty and very low-certainty evidence of the effectiveness of VR distraction compared to no distraction or other non-VR distraction in reducing acute pain intensity in children in any healthcare setting. This level of uncertainty makes it difficult to interpret the benefits or lack of benefits of VR distraction for acute pain in children. Most of the review primary outcomes were assessed by only two or three small studies. We found limited data for adverse effects and other secondary outcomes. Future well-designed, large, high-quality trials may have an important impact on our confidence in the results.
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Affiliation(s)
- Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Patrick Boylan
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Lorraine Boran
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Paula Hicks
- Centre for Innovative Human Systems, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Richard Kirubakaran
- Cochrane South Asia, Prof. BV Moses Centre for Evidence-Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Anne Matthews
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Hachimi-Idrissi S, Dobias V, Hautz WE, Leach R, Sauter TC, Sforzi I, Coffey F. Approaching acute pain in emergency settings; European Society for Emergency Medicine (EUSEM) guidelines-part 2: management and recommendations. Intern Emerg Med 2020; 15:1141-1155. [PMID: 32930964 DOI: 10.1007/s11739-020-02411-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In Europe, healthcare systems and education, as well as the clinical care and health outcomes of patients, varies across countries. Likewise, the management of acute events for patients also differs, dependent on the emergency care setting, e.g. pre-hospital or emergency department. There are various barriers to adequate pain management and factors common to both settings including lack of knowledge and training, reluctance to give opioids, and concerns about drug-seeking behaviour or abuse. There is no single current standard of care for the treatment of pain in an emergency, with management based on severity of pain, injury and local protocols. Changing practices, attitudes and behaviour can be difficult, and improvements and interventions should be developed with barriers to pain management and the needs of the individual emergency setting in mind. METHODS With these principles at the forefront, The European Society for Emergency Medicine (EUSEM) launched a programme-the European Pain Initiative (EPI)-with the aim of providing information, advice, and guidance on acute pain management in emergency settings. RESULTS AND CONCLUSIONS This article provides treatment recommendations from recently developed guidelines, based on a review of the literature, current practice across Europe and the clinical expertise of the EPI advisors. The recommendations have been developed, evaluated, and refined for both adults and children (aged ≥ 1 year, ≤ 15 years), with the assumption of timely pain assessment and reassessment and the possibility to implement analgesia. To provide flexibility for use across Europe, options are provided for selection of appropriate pharmacological treatment.
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Affiliation(s)
- Saïd Hachimi-Idrissi
- Department of Emergency Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | | | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Robert Leach
- Department of Emergency Medicine Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | | | - Frank Coffey
- Nottingham University Hospitals' NHS Trust, Nottingham, UK
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19
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Rischer KM, González-Roldán AM, Montoya P, Gigl S, Anton F, van der Meulen M. Distraction from pain: The role of selective attention and pain catastrophizing. Eur J Pain 2020; 24:1880-1891. [PMID: 32677265 PMCID: PMC7689692 DOI: 10.1002/ejp.1634] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 01/15/2023]
Abstract
Background Previous research has demonstrated the efficacy of cognitive engagement in reducing concurrent pain. However, little is known about the role of individual differences in inhibitory control abilities and negative pain‐related cognitions in modulating the magnitude of this type of distraction from pain. Methods In a pain distraction paradigm, 41 participants completed a working memory task with both a demanding high load condition (2‐back) and an easy low load condition (0‐back), while receiving warm or painful thermal stimuli to their left forearm. To control for individual differences in sensitivity to pain and perceived task difficulty, nociceptive stimulus intensity and task speed were individually calibrated. Additionally, participants completed a set of cognitive inhibition tasks (flanker, go/nogo, Stroop) and questionnaires about negative pain‐related cognitions (fear of pain, pain catastrophizing) prior to the distraction paradigm. Results As expected, engaging in the high load condition significantly reduced perceived intensity and unpleasantness of nociceptive stimuli, compared to the low load condition. The size of the distraction effect correlated significantly with better cognitive inhibition and selective attention abilities, as measured by the flanker task. A moderation analysis revealed a significant interaction between pain catastrophizing and performance in the flanker task in predicting the distraction effect size: Participants who performed well on the flanker task showed more pain reduction, but only when they were average to high pain catastrophizers. Conclusions Selective attention abilities and pain catastrophizing seem to be important factors in explaining individual differences in the size of the analgesic response to a distractive task. Significance Understanding which factors influence the effectiveness of cognitive engagement in distracting from pain could help to optimize its therapeutic application in patient care. This study shows that a complex interplay of cognitive inhibition abilities, specifically selective attention, and negative pain‐related cognitions, such as pain catastrophizing, modulate the magnitude of the distraction effect.
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Affiliation(s)
- Katharina M Rischer
- Department of Behavioural and Cognitive Sciences, Research Institute of Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Ana M González-Roldán
- Cognitive and Affective Neuroscience and Clinical Psychology, Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Pedro Montoya
- Cognitive and Affective Neuroscience and Clinical Psychology, Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Sandra Gigl
- Department of Behavioural and Cognitive Sciences, Research Institute of Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Fernand Anton
- Department of Behavioural and Cognitive Sciences, Research Institute of Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Marian van der Meulen
- Department of Behavioural and Cognitive Sciences, Research Institute of Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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20
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Rantala A, Pikkarainen M, Miettunen J, He HG, Pölkki T. The effectiveness of web-based mobile health interventions in paediatric outpatient surgery: A systematic review and meta-analysis of randomized controlled trials. J Adv Nurs 2020. [PMID: 32281673 DOI: 10.1111/jan.14381] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023]
Abstract
AIMS To evaluate the effectiveness of web-based mobile health interventions on paediatric patients and their parents in the day surgery context, where the primary outcome was children's pre-operative anxiety and secondary outcomes were postoperative pain and parents' anxiety and satisfaction with entire course of the day surgery. DESIGN A systematic review and meta-analysis of randomized controlled trials. DATA SOURCES CENTRAL, CINAHL, Scopus, Ovid MEDLINE, and Web of Science were systematically searched without time limits (up to December 2018). REVIEW METHODS Studies were appraised using the Cochrane risk of bias tool. A random effect meta-analysis of children's pre-operative anxiety was performed. RESULTS Eight studies with a total of 722 patients were included in the analysis. The effectiveness of web-based mobile health interventions, including age-appropriate videos, web-based game apps, and educational preparation games made for the hospital environment, was examined in pre-operative settings. A meta-analysis (N = 560 children) based on six studies found a statistically significant reduction in pre-operative anxiety measured by the Modified Yale Pre-operative Anxiety Scale with a moderate effect size. Three studies reported parental satisfaction. CONCLUSION Web-based mobile health interventions can reduce children's pre-operative anxiety and increase parental satisfaction. Web-based mobile health interventions could be considered as non-pharmacological distraction tools for children in nursing. There is not enough evidence regarding the effectiveness of reducing children's postoperative pain and parental anxiety using similar interventions. IMPACT Web-based mobile health interventions reduce children´s pre-operative anxiety and could therefore be considered as non-pharmacological distraction tools for children in nursing.
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Affiliation(s)
- Arja Rantala
- Research Unit of Nursing Science and Health Management, Faculty of Medicine Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Martti Ahtisaari Institute, Oulu Business School, VTT, Oulu University, Technical Research Centre of Finland, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | - Tarja Pölkki
- Department of Children and Women, Medical Research Center, Oulu University Hospital, Oulu, Finland.,The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
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21
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Chen YJ, Cheng SF, Lee PC, Lai CH, Hou IC, Chen CW. Distraction using virtual reality for children during intravenous injections in an emergency department: A randomised trial. J Clin Nurs 2019; 29:503-510. [PMID: 31715039 DOI: 10.1111/jocn.15088] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/03/2019] [Accepted: 10/20/2019] [Indexed: 01/13/2023]
Abstract
AIM AND OBJECTIVES To determine whether the virtual reality as a distracting intervention could reduce pain and fear in school-age children receiving intravenous injections at an emergency department. BACKGROUND An intravenous injection is the most common invasive procedure that paediatric patients encounter in emergency department. School-age children seldom show their fear or discomfort during the procedure which may be ignored. DESIGN A randomised controlled trial was conducted from December 2017-May 2018 and performed according to the CONSORT guidelines. METHODS One hundred and thirty-six children aged 7-12 years were randomly allocated to receive either a routine intravenous injection procedure or one with an immersive virtual reality experience. Children were asked to rate their pain and fear along with their caregivers and nurses on the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale, respectively. The time required for successful intravenous insertion was also assessed in the emergency department. Clinical trial registration was done (ClinicalTrials.gov.: NCT04081935). RESULTS Pain and fear scores were significantly lower in the virtual reality group, as were the children's ratings as perceived by their caregivers and nurses. The children's ratings of pain and fear were positively correlated with the caregivers' ratings and the nurses' ratings as well. The time required for successful intravenous insertion was significantly lower in the virtual reality group. CONCLUSION Visual reality intervention can effectively reduce the pain and fear during intravenous procedure in school-age children in emergency department. RELEVANCE TO CLINICAL PRACTICE The results of this study indicate the feasible clinical value of virtual reality interventions during the administration of intravenous injections in school-age children in emergency departments.
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Affiliation(s)
- Yen-Ju Chen
- Department of Nursing, National Yang-Ming University Hospital, Yilan, Taiwan.,School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Pi-Chang Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Hsiu Lai
- Department of Nursing, National Yang-Ming University Hospital, Yilan, Taiwan
| | - I-Ching Hou
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Wen Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
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22
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Reducing Pain and Fear in Children During Venipuncture: A Randomized Controlled Study. Pain Manag Nurs 2019; 21:276-282. [PMID: 31501078 DOI: 10.1016/j.pmn.2019.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/17/2019] [Accepted: 07/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Venous blood sampling is a common procedure in the hospital setting and cause significant pain and stress for children. AIM This study was conducted to determine and compare the effects of balloon inflation, ball squeezing, and coughing methods on levels of pain and fear during venipuncture in children aged 7-12 years. DESIGN Experimental, randomized controlled study. SETTING The study was conducted at a state hospital in Turkey between March and July 2017. PARTICIPANTS/SUBJECTS The study population comprised children 7-12 years of age who were subjected to venous blood sampling in the phlebotomy unit of a state hospital. The study sample included 120 children for a confidence interval of 95% and statistical power of 80%. METHODS The children were assigned to one of four groups (balloon inflation, ball squeezing, coughing, and control groups), each including 30 participants. The children's pain and fear were rated before and after the procedure by the children themselves, their parents, and a researcher using the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale, respectively. RESULTS Mean scores for pain and fear after the procedure were lower in all intervention groups compared with the control group (p = .001). There was no statistical difference in pain or fear scores between the intervention groups; however, the children in the coughing group had the lowest scores for both pain and fear. CONCLUSION Balloon inflation, ball squeezing, and coughing were all effective in reducing pain and fear associated with venipuncture in children aged 7-12 years. These are simple, rapid, and cost-effective methods that nurses can implement during venipuncture with minimal equipment and preparation.
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23
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Martin SD, John LD. Framework to Explain the Progression of Pain in Obese or Overweight Children Undergoing Tonsillectomy. J Perianesth Nurs 2019; 34:1106-1119. [PMID: 31307907 DOI: 10.1016/j.jopan.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/27/2019] [Accepted: 03/31/2019] [Indexed: 12/16/2022]
Abstract
An estimated 100,000 obese (OB) and overweight (OW) children undergo tonsillectomy each year in the United States. Pain management in this population is particularly challenging because of weight-based dosing, clinician fears, potential for airway obstruction, and genetic differences. A framework is proposed to explain factors involved in the post-tonsillectomy pain (PTP) experience in OB and OW children. The tonsillectomy, the body's inflammatory state, and mechanical stressors comprise influencing factors in PTP progression. Clinician-delivered medication doses, genetic variants of drug metabolism, and soothing factors serve as mediating factors in the progression of PTP. Postanesthesia care unit (PACU) nurses may use this framework to better understand PTP progression in OB and OW children. PACU nurses may manipulate certain mediating factors discussed in this framework to moderate PTP progression in OB and OW children. Researchers may use this framework to support future research to improve PTP management in OB and OW children.
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24
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The Impact of 3 Different Distraction Techniques on the Pain and Anxiety Levels of Children During Venipuncture. Clin J Pain 2019; 35:140-147. [DOI: 10.1097/ajp.0000000000000666] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Horton Smith L. The introduction of play specialists as operating department escorts for children. J Perioper Pract 2018; 29:378-381. [PMID: 30565522 DOI: 10.1177/1750458918817998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Attending theatre for a surgical procedure can be a very stressful time for both children and their parents and guardians, with ward staff accompanying patients to the operating department to provide support. A local Trust proposed a change from the deployment of registered nurses to the utilisation of play specialists as escorts for children on their journey to theatre and during the induction of anaesthesia to improve patient experience, levels of registered staff remaining on the children’s ward and theatre efficiency. It was found that in children who had not received premedication, this substitution can be completed successfully, providing that the play specialists receive sufficient training to carry out this role effectively.
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26
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Comparison of the Effects of Drawing Pictures and Inflating Balloons on Anxiety and Pain Caused by Diphtheria-Pertussis-Tetanus Immunization in School-Aged Children. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2018. [DOI: 10.5812/pedinfect.12332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Zhu L, Chan WCS, Liam JLW, Xiao C, Lim ECC, Luo N, Cheng KFK, He HG. Effects of postoperative pain management educational interventions on the outcomes of parents and their children who underwent an inpatient elective surgery: A randomized controlled trial. J Adv Nurs 2018; 74:1517-1530. [DOI: 10.1111/jan.13573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Lixia Zhu
- Department of Pharmacology; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
- National University Health System; Singapore Singapore
| | - Wai-Chi Sally Chan
- School of Nursing and Midwifery; Faculty of Health and Medicine; The University of Newcastle; Callaghan NSW Australia
| | - Joanne Li Wee Liam
- Division of Nursing; KK Women's and Children's Hospital; Singapore Singapore
| | | | | | - Nan Luo
- Saw Swee Hock School of Public Health; National University of Singapore; National University Health System; Singapore Singapore
| | - Kin Fong Karis Cheng
- National University Health System; Singapore Singapore
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Hong-Gu He
- National University Health System; Singapore Singapore
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
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Abstract
There is a long history of using videogames in a therapeutic capacity including rehabilitation for stroke patients, people with traumatic brain injuries, burns victims, wheelchair users, Erb's palsy sufferers, children undergoing chemotherapy, children with muscular dystrophy, autistic children and individuals looking to overcome real-life challenges (including symptoms of depression) and boost their wellbeing (including boosting life satisfaction, self-efficacy and social support). This paper briefly and selectively examines a number of areas including: (1) videogames as physiotherapy and occupational therapy, (2) videogames as distractors in the role of pain management, (3) videogames and cognitive rehabilitation, (4) videogames and the development of social and communication skills among the learning disabled, (5) videogames and impulsivity/attention deficit disorders, (6) videogames and therapeutic benefits in the elderly, (7) videogames in psychotherapeutic settings, (8) videogames and health care, (9) videogames and anxiety disorders, and (10) videogames and psychological wellbeing. It is concluded that there has been considerable success when games are specifically designed to address a specific problem or to teach a certain skill. However, generalizability outside the game-playing situation remains an important consideration.
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Affiliation(s)
- Mark D. Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Daria J. Kuss
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Angelica B. Ortiz de Gortari
- International Gaming Research Unit, Psychology Division, Nottingham Trent University, Nottingham, UK & Psychology and Neuroscience of Cognition Research Unit, University of Liège, Belgium
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Zou Z, Liu Y, Xie J, Huang X. Aerobic Exercise As a Potential Way to Improve Self-Control after Ego-Depletion in Healthy Female College Students. Front Psychol 2016; 7:501. [PMID: 27148113 PMCID: PMC4834755 DOI: 10.3389/fpsyg.2016.00501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/23/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose: To test whether aerobic exercise can help build self-control stamina in healthy female young adults. Stamina in this context is defined as the capability to endure ego depletion, which can be measured with a self-control task following another activity also requiring self-control. Methods: Forty-five healthy undergraduate women were randomized to either an experimental group or control group. Participants in the experimental group were required to run in their campus running field for 30 min for a period of 5 weeks. Individuals in the control group were required to do diary entries regarding self-control in their daily lives, also for a period of 5 weeks. Before and after the 5-week intervention, participants completed a pain threshold test, a color word Stroop task and the following Cold Pressor Task (CPT) (with and without a distraction component). Results: There was significant decrease of pain tolerance in session 2 relative to session 1 in the control group, but no such decline was found in the experimental group (though the improvement of pain tolerance was not significant), possibly suggesting successful self-control against this kind of decline. Conclusions: Five weeks of aerobic exercise increased self-control after ego depletion in terms of pain tolerance. These findings suggest that aerobic exercise may serve as a potential effective intervention for enhancing self-control in a college female population.
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Affiliation(s)
- Zhiling Zou
- Faculty of Psychology, Southwest University Chongqing, China
| | - Yang Liu
- Faculty of Psychology, Southwest University Chongqing, China
| | - Jing Xie
- Faculty of Psychology, Southwest University Chongqing, China
| | - Xiting Huang
- Faculty of Psychology, Southwest University Chongqing, China
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30
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Tagg A, Goldstein H, Davis T, Lawton B. Sticks and stones may break some bones. Emerg Med Australas 2016; 28:4-6. [DOI: 10.1111/1742-6723.12531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew Tagg
- Emergency Department, Footscray Hospital; Melbourne Victoria Australia
| | - Henry Goldstein
- Emergency Department, Lady Cilento Children's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Tessa Davis
- Emergency Department, Sydney Children's Hospital; Sydney New South Wales Australia
| | - Ben Lawton
- Emergency Department, Lady Cilento Children's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Emergency Department, Logan Hospital; Logan City Queensland Australia
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31
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Waldon EG, Lesser A, Weeden L, Messick E. The Music Attentiveness Screening Assessment, Revised (MASA-R): A Study of Technical Adequacy. J Music Ther 2015; 53:75-92. [PMID: 26673955 DOI: 10.1093/jmt/thv021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/16/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evidence suggests that attention is an important consideration when designing procedural support interventions for children undergoing distressing medical procedures. As such, the extent to which children can attend to musical stimuli used during music-based procedural support interventions would seem important. The Music Attentiveness Screening Assessment (MASA) was designed to assess a child's ability to attend to musical stimuli, but further revisions were deemed necessary to improve administration, test-retest reliability, and interobserver agreement for the measure's items. OBJECTIVE This study investigated the technical adequacy of the Music Attentiveness Screening Assessment, Revised (MASA-R), with a non-clinical sample of children aged 4 to 9 years by examining (a) Construct validity using comparator instruments measuring auditory attention; (b) Test-retest reliability following a two-week delay; and (c) Interobserver agreement when administered by two independent examiners. METHODS This non-clinical sample included 69 children who were administered both items from MASA-R and two comparator instruments: the Auditory Attention subtest from the NEPSY-II (NII-AA) for children aged 5 to 9 years (n = 47); and the Auditory Attention subtest from the Woodcock-Johnson Tests of Cognitive Abilities, 3rd ed. (WJIII-AA), for children aged 4 years (n = 22). RESULTS A significant proportion of score variance was shared by both MASA-R items and the comparator measures: R (2) = .16, F(2, 66) = 6.30, p = .003. MASA-R score estimates with regard to test-retest reliability (Item I, intra-class correlation [ICC] = .88; Item II, ICC = .91) and interobserver agreement (Item I, ICC = .99; Item II, ICC = .98) also fell into acceptable ranges. CONCLUSIONS Estimates of MASA-R score construct validity, test-retest reliability, and interobserver agreement appear improved over its predecessor, MASA. While findings are promising, additional investigation of its use with a clinical sample is needed before it can be confidently used in pediatrics.
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32
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Mutlu B, Balcı S. Effects of balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples: a randomized controlled trial. J SPEC PEDIATR NURS 2015; 20:178-86. [PMID: 25817062 DOI: 10.1111/jspn.12112] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose was to determine the effects of the balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples. DESIGN AND METHODS In this prospective randomized controlled study, 9- to 12-year-old children in the intervention groups were asked to cough or inflate balloons during the venipuncture procedure. The Faces Pain Scale-Revised was used to assess pain intensity. RESULTS Pain intensity significantly differed between the control (n = 44) and intervention groups (balloon inflation [n = 44] and cough trick [n = 44], p < .001). PRACTICE IMPLICATIONS Coughing and inflating balloons during venipuncture do not require preparation and are time saving, easy, accessible, and effective in reducing pain.
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Affiliation(s)
- Birsen Mutlu
- Istanbul University Florence Nightingale Nursing Faculty-Pediatric Nursing, Istanbul, Turkey
| | - Serap Balcı
- Istanbul University Florence Nightingale Nursing Faculty-Pediatric Nursing, Istanbul, Turkey
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33
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Boerner KE, Noel M, Birnie KA, Caes L, Petter M, Chambers CT. Impact of Threat Level, Task Instruction, and Individual Characteristics on Cold Pressor Pain and Fear among Children and Their Parents. Pain Pract 2015; 16:657-68. [PMID: 26011606 DOI: 10.1111/papr.12306] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/10/2015] [Indexed: 11/27/2022]
Abstract
The cold pressor task (CPT) is increasingly used to induce experimental pain in children, but the specific methodology of the CPT is quite variable across pediatric studies. This study examined how subtle variations in CPT methodology (eg. provision of low- or high-threat information regarding the task; provision or omission of maximum immersion time) may influence children's and parents' perceptions of the pain experience. Forty-eight children (8 to 14 years) and their parents were randomly assigned to receive information about the CPT that varied on 2 dimensions, prior to completing the task: (i) threat level: high-threat (task described as very painful, high pain expressions depicted) or low-threat (standard CPT instructions provided, low pain expressions depicted); (ii) ceiling: informed (provided maximum immersion time) or uninformed (information about maximum immersion time omitted). Parents and children in the high-threat condition expected greater child pain, and these children reported higher perceived threat of pain and state pain catastrophizing. For children in the low-threat condition, an informed ceiling was associated with less state pain catastrophizing during the CPT. Pain intensity, tolerance, and fear during the CPT did not differ by experimental group, but were predicted by child characteristics. Findings suggest that provision of threatening information may impact anticipatory outcomes, but experienced pain was better explained by individual child variables.
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Affiliation(s)
- Katelynn E Boerner
- Departments of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Melanie Noel
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, Washington, U.S.A
| | - Kathryn A Birnie
- Departments of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Line Caes
- Department of Psychology and Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Mark Petter
- Victoria Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Christine T Chambers
- Departments of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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34
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Seiden SC, McMullan S, Sequera-Ramos L, De Oliveira GS, Roth A, Rosenblatt A, Jesdale BM, Suresh S. Tablet-based Interactive Distraction (TBID) vs oral midazolam to minimize perioperative anxiety in pediatric patients: a noninferiority randomized trial. Paediatr Anaesth 2014; 24:1217-23. [PMID: 25040433 DOI: 10.1111/pan.12475] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Perioperative anxiety is a common and undesirable outcome in pediatric surgical patients. The use of interactive tools to minimize perioperative anxiety is vastly understudied. The main objective of the current investigation was to compare the effects of a tablet-based interactive distraction (TBID) tool to oral midazolam on perioperative anxiety. We hypothesized that the TBID tool was not inferior to midazolam to reduce perioperative anxiety. METHODS 108 children, ages 1-11 years, presenting for outpatient surgical procedures were prospectively randomized to oral midazolam (0.5 mg·kg(-1); 20 mg max) or TBID. The primary outcome was the change in anxiety level from baseline to parental separation and anesthetic induction. Other data collected included emergence delirium, parental satisfaction, time-to-PACU discharge, and posthospitalization behavior. RESULTS The mean difference (95% CI) in the increase of anxiety at parental separation between the TBID and the midazolam group was -9 (-2.6 to -16.4), P = 0.006, demonstrating superiority to midazolam group (one-sided P = 0.003). For children 2-11 years, the mean difference (95% CI) in anxiety at induction was significant between the TBID and midazolam groups, -14.0 (-6.1 to -22.0), P < 0.001. The median (IQR) time-to-PACU discharge was 111 (75-197) min in the midazolam group and 87 (55-137) min in the TBID group, P = 0.03. Decreased emergence delirium and increased parental satisfaction were also observed in the TBID group. CONCLUSIONS A TBID tool reduces perioperative anxiety, emergence delirium, and time-to-discharge and increases parental satisfaction when compared to midazolam in pediatric patients undergoing ambulatory surgery.
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Affiliation(s)
- Samuel C Seiden
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
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Loreto-Quijada D, Gutiérrez-Maldonado J, Nieto R, Gutiérrez-Martínez O, Ferrer-García M, Saldaña C, Fusté-Escolano A, Liutsko L. Differential effects of two virtual reality interventions: distraction versus pain control. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2014; 17:353-8. [PMID: 24892197 DOI: 10.1089/cyber.2014.0057] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is evidence that virtual reality (VR) pain distraction is effective at improving pain-related outcomes. However, more research is needed to investigate VR environments with other pain-related goals. The main aim of this study was to compare the differential effects of two VR environments on a set of pain-related and cognitive variables during a cold pressor experiment. One of these environments aimed to distract attention away from pain (VRD), whereas the other was designed to enhance pain control (VRC). Participants were 77 psychology students, who were randomly assigned to one of the following three conditions during the cold pressor experiment: (a) VRD, (b) VRC, or (c) Non-VR (control condition). Data were collected regarding both pain-related variables (intensity, tolerance, threshold, time perception, and pain sensitivity range) and cognitive variables (self-efficacy and catastrophizing). Results showed that in comparison with the control condition, the VRC intervention significantly increased pain tolerance, the pain sensitivity range, and the degree of time underestimation. It also increased self-efficacy in tolerating pain and led to a reduction in reported helplessness. The VRD intervention significantly increased the pain threshold and pain tolerance in comparison with the control condition, but it did not affect any of the cognitive variables. Overall, the intervention designed to enhance control seems to have a greater effect on the cognitive variables assessed. Although these results need to be replicated in further studies, the findings suggest that the VRC intervention has considerable potential in terms of increasing self-efficacy and modifying the negative thoughts that commonly accompany pain problems.
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Affiliation(s)
- Desirée Loreto-Quijada
- 1 Department of Personality, Assessment, and Psychological Treatments, University of Barcelona , Spain
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36
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Waldon EG, Broadhurst E. Construct Validity and Reliability of the Music Attentiveness Screening Assessment (MASA). J Music Ther 2014; 51:154-70. [DOI: 10.1093/jmt/thu008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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37
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Birnie KA, Caes L, Wilson AC, Williams SE, Chambers CT. A practical guide and perspectives on the use of experimental pain modalities with children and adolescents. Pain Manag 2014; 4:97-111. [PMID: 24641434 PMCID: PMC4110966 DOI: 10.2217/pmt.13.72] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Use of experimental pain is vital for addressing research questions that would otherwise be impossible to examine in the real world. Experimental induction of pain in children is highly scrutinized given the potential for harm and lack of direct benefit to a vulnerable population. However, its use has critically advanced our understanding of the mechanisms, assessment and treatment of pain in both healthy and chronically ill children. This article introduces various experimental pain modalities, including the cold pressor task, the water load symptom provocation test, thermal pain, pressure pain and conditioned pain modulation, and discusses their application for use with children and adolescents. It addresses practical implementation and ethical issues, as well as the advantages and disadvantages offered by each task. The incredible potential for future research is discussed given the array of experimental pain modalities now available to pediatric researchers.
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Affiliation(s)
- Kathryn A Birnie
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research (West), K8536 (8th floor, Children's site), Izaak Walton Killam Health Centre, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Line Caes
- Centre for Pediatric Pain Research (West), K8536 (8th floor, Children's site), Izaak Walton Killam Health Centre, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Anna C Wilson
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, OR, USA
| | - Sara E Williams
- Cincinnati Children's Hospital Medical Center & Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
| | - Christine T Chambers
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research (West), K8536 (8th floor, Children's site), Izaak Walton Killam Health Centre, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Canada
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Podină IR, Koster EHW, Philippot P, Dethier V, David DO. Optimal attentional focus during exposure in specific phobia: a meta-analysis. Clin Psychol Rev 2013; 33:1172-83. [PMID: 24185091 DOI: 10.1016/j.cpr.2013.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 09/10/2013] [Accepted: 10/02/2013] [Indexed: 11/17/2022]
Abstract
Over the last 30 years, researchers have disagreed over the consequences of diverting attention from threat for exposure efficacy, which is an important theoretical and clinical debate. Therefore, the present meta-analysis assessed the efficacy of attentionally focused exposure against distracted and attentionally uninstructed exposure regarding distress, behavioral, and physiological outcomes. We included 15 randomized studies with specific phobia, totaling 444 participants and targeting outcomes at post-exposure and follow-up. Results indicated no difference between the efficacy of distracted exposure as opposed to focused or uninstructed exposure for distress and physiology. For behavior, at post-exposure, results were marginally significant in favor of distracted as opposed to focused exposure, while at follow-up results significantly favored distraction. However, concerning behavior, uninstructed exposure was superior to distraction. Moderation analyses revealed that, regarding distress reduction and approach behavior, distracted exposure significantly outperformed focused exposure when the distracter was interactive (g=1.010/g=1.128) and exposure was spread over the course of multiple sessions (g=1.527/g=1.606). No moderation analysis was significant for physiological measures. These findings suggest that distraction during exposure could be less counterproductive than previously considered and even beneficial under certain circumstances. Theoretical implications and future directions for research are discussed.
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Affiliation(s)
- Ioana R Podină
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, No. 37, Republicii St., 400015 Cluj-Napoca, Romania.
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Lambert V, Matthews A, Hicks P, Boran L, Devane D. Virtual reality simulation for reducing pain in children. Hippokratia 2013. [DOI: 10.1002/14651858.cd010686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Veronica Lambert
- Dublin City University; School of Nursing and Human Sciences; Collins Avenue Dublin Ireland 9
| | - Anne Matthews
- Dublin City University; School of Nursing and Human Sciences; Collins Avenue Dublin Ireland 9
| | - Paula Hicks
- Trinity College Dublin; Office of the Vice Provost; College Green Dublin Ireland 2
| | - Lorraine Boran
- Dublin City University; School of Nursing and Human Sciences; Collins Avenue Dublin Ireland 9
| | - Declan Devane
- National University of Ireland Galway; School of Nursing and Midwifery; University Road Galway Ireland
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40
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Sadeghi T, Mohammadi N, Shamshiri M, Bagherzadeh R, Hossinkhani N. Effect of distraction on children's pain during intravenous catheter insertion. J SPEC PEDIATR NURS 2013; 18:109-14. [PMID: 23560582 DOI: 10.1111/jspn.12018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/27/2012] [Accepted: 12/27/2012] [Indexed: 12/24/2022]
Abstract
PURPOSE This study examined the effect of pressing a soft ball during intravenous catheter insertion (IVCI) on the intensity of pain in children ages 4-6 years. DESIGN AND METHODS In this quasi-experimental study, children in the intervention group were asked to press a soft ball with the opposite hand during IVCI and to immediately mark the Wong-Baker FACES Pain Rating Scale. RESULTS There was a significant difference in the intensity of pain between the control group (n = 30) and the intervention group (n = 30; p =.012). PRACTICE IMPLICATIONS Pressing a soft ball during IVCI may be an easily accessed, inexpensive, and effective technique to control or reduce pain in young children.
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Affiliation(s)
- Tahereh Sadeghi
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences and Health Services, Tehran, Iran
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41
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Sil S, Dahlquist LM, Burns AJ. Case study: videogame distraction reduces behavioral distress in a preschool-aged child undergoing repeated burn dressing changes: a single-subject design. J Pediatr Psychol 2012; 38:330-41. [PMID: 23248343 DOI: 10.1093/jpepsy/jss128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This single-subject design study evaluated the feasibility and efficacy of passive and interactive videogame distraction on behavioral distress for a preschool-aged child receiving repeated burn dressing changes. METHOD A 4-year-old girl underwent 3 baseline and 10 videogame distraction sessions (5 passive and 5 interactive) using a restricted alternating treatments design. Observed behavioral distress was coded, and parents and nurses rated the child's distress and cooperative behavior. RESULTS Relative to baseline, behavioral distress decreased and cooperative behavior increased immediately after the onset of videogame distraction. Single Case Randomization Tests revealed significantly lower behavioral distress and greater cooperation during interactive videogame distraction relative to passive videogame distraction. CONCLUSIONS Interactive videogame distraction appears to be a feasible and effective pain management strategy for a preschool-aged child undergoing repeated painful medical procedures.
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Affiliation(s)
- Soumitri Sil
- Department of Psychology, University of Maryland, Baltimore, MD 21250, USA
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