The Cochrane Library and procedural pain in children: an overview of reviews

Background: Procedural pain in children is highly prevalent, a major source of pain, stress and anxiety, and can have negative short- and long-term effects. Research addressing effective pain management strategies is complex, presenting challenges for clinically relevant synthesis. Objective: To summarize Cochrane reviews assessing the effects of various interventions used for pain in non-neonatal children undergoing painful medical procedures. Methods: The Cochrane Database of Systematic Reviews was systematically searched for reviews of interventions for pain in children outside of the neonatal period, undergoing painful medical procedures. The type of data to be extracted was determined a priori, and a single author performed data extraction. The Cochrane Library was searched using the terms ‘procedural pain’ and ‘procedures’. Reviews examining acute procedural pain in older infants, children and adolescents were included. Interventions included topical anaesthetics (eutectic mixture of local anaesthetics and amethocaine), sweet tasting substances, cognitive therapy, behavioural therapy and combined cognitive-behavioural therapy(CBT). Data on self-reported, behavioural and observer pain intensity and pain distress were extracted. Main results: Four systematic reviews were included in the overview. There was evidence that self-reported pain [risk ratio (RR) 0.63; 95% confidence interval (CI) 0.45–0.87], behavioural measures of pain (RR 0.71; 95% CI 0.52–0.96) and all pain scales combined (RR 0.69; 95% CI 0.55–0.87) were significantly less with amethocaine than with eutectic mixture of local anaesthetics. Results of trials of other interventions are reported in this article but heterogeneity of the combined effects is high. Authors' conclusions: Amethocaine provides superior pain relief when compared with eutectic mixture of local anaesthetics for the procedure of intravenous cannulation. From the data contained in this overview, there is no current evidence of benefit supporting the use of 12% sucrose for older infants and toddlers or sweet gum for toddlers undergoing needle pain. Potentially efficacious nonpharmacological interventions may include distraction, hypnosis, combined cognitive-behavioural interventions, non-nutritive sucking and video distraction; however, further research is required as results are mixed. An integrated approach using multiple modalities encompassing both the physiological and psychological aspects of pain is compelling and warrants further study in paediatrics. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration