Pain in child patients: A review on managements

Non-pharmacological interventions to reduce procedural needle pain in children (6-12 years): A systematic review

PROBLEM

Children of different age groups frequently undergo painful procedures involving needles, which can be a source of significant discomfort. Regrettably, this aspect of care often receives insufficient attention from healthcare professionals. The existing literature proposes several methodologies for managing procedural pain, with nonpharmacological techniques being particularly promising. These techniques should be adapted to the patient's age, but literature predominantly emphasizes their use with infants. Thus, it is necessary to evaluate their effectiveness in diverse age groups. Consequently, the purpose of this systematic review is to identify non-pharmacological interventions used to prevent needle-related procedural pain in children (age group 6-12 years).

ELIGIBILITY CRITERIA

Primary studies in English language on non-pharmacological interventions in children aged 6-12 years undergoing needle-related procedures found on PubMed, CINAHL and Embase.

SAMPLE

A total of 18 studies were included.

RESULTS

The results indicate the potential application of various non-pharmacological techniques, with distraction methods standing out. These techniques include activities like utilizing cards, watching cartoons, employing virtual reality and playing video games.

CONCLUSIONS

Children's procedural pain represents a significant challenge in treatment plans. Literature offers several approaches, including nonpharmacologic methods, to control this problem. Prioritizing procedural pain management is critical both at clinical and organizational levels to improve the quality of pediatric care.

IMPLICATIONS

These findings offer different options to support clinical practice, holding the potential to enhance the quality of patient care.

Effects of two different ball types on pain and anxiety during venous blood draw in children: A randomized controlled study

BACKGROUND

Children presenting to hospitals for healthcare are often exposed to venous blood draw procedures which cause significant pain and stress for children.

OBJECTIVES

Tactile stimulation and active distraction methods can be used during procedural pain management in children. This study was conducted to determine and compare the effects of tactile stimulation and active distraction methods on levels of pain and anxiety during venous blood draw procedure in children.

METHODS

A randomized controlled study design was adopted with a parallel trial design to compare four different intervention groups with a control group. The children's anxiety levels were evaluated using the Children's Fear Scale, and their perceived pain levels were evaluated using the Wong Baker Pain Scale.

RESULTS

The results of the child and observer evaluations revealed the perceived level of pain during the procedure to be lower in the intervention groups than in the control group, and lower in the spiky ball groups than in the round ball groups. The level of anxiety during the procedure was found to be significantly lower than that recorded prior to the procedure, based on the self-evaluation of the child and the evaluation of the observer in the intervention groups. A positive correlation was found between pain and anxiety levels during the procedure.

PRACTICE IMPLICATIONS

The results of this study support the effectiveness of the spiky ball method to reduce perceived pain and anxiety in children during venous blood draw procedures in the pediatric blood draw units.

Chronic neuropathic pain is more than a perception: Systems and methods for an integral characterization

The management of chronic neuropathic pain remains a challenge, because pain is subjective, and measuring it objectively is usually out of question. However, neuropathic pain is also a signal provided by maladaptive neuronal activity. Thus, the integral management of chronic neuropathic pain should not only rely on the subjective perception of the patient, but also on objective data that measures the evolution of neuronal activity. We will discuss different objective and subjective methods for the characterization of neuropathic pain. Additionally, the gaps and proposals for an integral management of chronic neuropathic pain will also be discussed. The current management that relies mostly on subjective measures has not been sufficient, therefore, this has hindered advances in pain management and clinical trials. If an integral characterization is achieved, clinical management and stratification for clinical trials could be based on both questionnaires and neuronal activity. Appropriate characterization may lead to an increased effectiveness for new therapies, and a better quality of life for neuropathic pain sufferers.

Identification of Neuropathic Pain Severity based on Linear and Non-Linear EEG Features

The lack of an integral characterization of chronic neuropathic pain (NP) has led to pharmacotherapy mismanagement and has hindered advances in clinical trials. In this study, we attempted to identify chronic NP by fusing psychometric (based on the Brief Inventory of Pain - BIP), and both linear and non-linear electroencephalographic (EEG) features. For this purpose, 35 chronic NP patients were recruited voluntarily. All the volunteers answered the BIP; and additionally, 22 EEG channels positioned in accordance with the 10/20 international system were registered for 10 minutes at resting state: 5 minutes with eyes open and 5 minutes with eyes closed. EEG Signals were sampled at 250 Hz within a bandwidth between 0.1 and 100 Hz. As linear features, absolute band power was obtained per clinical frequency band: delta (0.1~4 Hz), theta (4~8 Hz), alpha (8~12 Hz), beta (12~30 Hz) and gamma (30~100 Hz); considering five regions: prefrontal, frontal, central, parietal and occipital. As non-linear features, approximate entropy was calculated per channel and per clinical frequency band with addition of the broadband (0.1~100 Hz). Resulting feature vectors were grouped in line with the BIP outcome. Three groups were considered: low, moderate, and high pain. Finally, BIP-EEG patterns were classified in those three classes, achieving 96% accuracy. This result improves a previous work of a SVM classifier that used exclusively linear EEG features and showed an accuracy between 87% and 90% per class to predict central NP after spinal cord injury.