Nonpharmacologic Therapy for Pediatric Posttonsillectomy Pain: A Systematic Review.

Objective: To understand efficacies of nonpharmacologic therapy for pediatric posttonsillectomy pain. Data Sources: CINAHL, Cochrane Library, PubMed, and Scopus. Review Methods: Studies on nonpharmacologic interventions for pediatric posttonsillectomy pain were included in this systematic review. Extracted variables included demographics, pain scores, and postoperative bleeding. Pain scores on 0-10 scales (eg, Visual Analog Scale, Wong-Baker, FLACC, Oucher) were analyzed, and scales using different ranges, but comparable pain markers, were standardized to 0 to 10. Data were summarized as means, proportions (%), and differences (Δ) with 95% confidence intervals (CI). Risk of bias was evaluated using the Joanna Briggs Institute (JBI), ROBINS-I, or ROB-2 tools. Results: Twenty-three studies (n = 3538) met inclusion criteria. Several nonpharmacologic intervention groups showed significant reductions in postoperative pain compared to control. At 6 hours postoperatively, acupuncture (∆ −0.8, 95% CI [−1.17, −0.43], P <.01), ice cream (∆ −1.4, 95% CI [−2.28, −0.52], P <.01), cartoon distraction (∆ −1.3, 95% CI [−1.83, −0.77], P <.01), and lavender essence inhalation (∆ −0.9, 95% CI [−1.76, −0.04], P =.04), were associated with lower pain scores. By postoperative Day 7 sugar-free gum was the only intervention associated with lower pain scores (∆ −2.2, 95% CI [−3.07, −1.33], P <.01). Salvia officinalis, cold diet, and food and effort restrictions were associated with less postoperative bleeding. Honey, intraoperative music, autologous serum, and liquid/soft diet (among other interventions) showed no changes in postoperative pain. Conclusions: Nonpharmacologic interventions including acupuncture, sugar-free gum, distraction, and select oil essence therapies are associated with less pain, with some interventions reducing postoperative bleeding risk. This supports incorporating non-pharmacologic adjuncts for pediatric posttonsillectomy pain, though further high-quality studies are needed. © 2026 The Author(s). Otolaryngology-Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology-Head and Neck Surgery Foundation.