The Impact of Parental Presence on Their Children During Painful Medical Procedures: A Systematic Review

Objective Whether parental presence during their children’s painful medical procedures is advantageous with regard to children’s pain-related outcomes is questionable. Research on this topic is equivocal, and additional questions, such as whether levels of parental involvement may play a role as well, remain to be addressed. The purpose of this systematic review is to summarize and critically appraise the literature on the impact of parental presence vs absence during their children’s painful medical procedures on the child’s pain-related outcomes. Methods The review protocol was registered on Prospero (ID CRD42018116614). A systematic search in PubMed, Web of Science, and PsycArticles resulted in 22 eligible studies incorporating 2,157 participants. Studies were considered eligible if they included children (≤18 years old) undergoing a painful medical procedure and compared parental presence and/or involvement with parental absence during the procedure. Results The children’s pain-related outcomes included self-reported pain intensity, self-reported fear, anxiety and distress, observed pain-related behavior, and physiological parameters. Overall, evidence points in the direction of beneficial effects of parental presence vs absence with regard to children’s self-reported pain intensity and physiological parameters, whereas mixed findings were recorded for children’s self-reported fears, anxiety and distress, and observed pain-related behaviors. Conclusions To provide clear recommendations on how to involve the parent during the procedure, as well as for which type of children and parents parental presence has the best effects, further research is needed, as indicated in this review.

Effects of Green Color Exposure on Stress, Anxiety, and Pain during Peripheral Intravenous Cannulation in Dental Patients Requiring Sedation

Intravenous cannulation is an invasive procedure that causes stress, anxiety, and pain for many patients. A recent animal study found that exposure to green light induced antinociceptive and anxiolytic effects. This study examined whether green color exposure reduced stress, anxiety, and pain during peripheral intravenous cannulation (PIC) for sedation in dental patients. In this controlled clinical trial, 24 patients (mean age 40.9 years) were randomized to wear clear glasses or green-colored glasses for 15 min before PIC on two separate days in a cross-over manner. The primary outcome measures were salivary alpha-amylase (sAA) activity and stress-related hemodynamic changes, and the secondary outcome measures were the visual analog scale anxiety (VAS-A) and pain (VAS-P) scores during PIC. The sAA level in the clear group significantly increased during PIC compared with baseline, but did not increase in the green group. Median VAS-P scores during PIC were lower in the green group than in the clear group (VAS-P, 17.0 vs. 50.0). Green color exposure with glasses significantly reduced stress and pain during PIC without any adverse effects. This simple, safe, and effective method may be useful during painful medical procedures.

Underpredicting Pain: An experimental investigation into the benefits and risks - Preprint

Expectancies can shape pain and other experiences. Generally, experiences change in the direction of what is expected (i.e., assimilation effects), as seen with placebo effects. However, in case of large expectation-experience discrepancies, experiences might change away from what is expected (i.e., contrast effects). Previous research has demonstrated contrast effects on various outcomes, but not pain. We investigated the effects of strong underpredictions of pain on experienced pain intensity. Additionally, we assessed related outcomes including (certainty of) expectations, fear of pain, pain unpleasantness, autonomic responses, and trust. Healthy participants (Study 1: n=81, Study 2: n=123) received verbal suggestions that subsequent heat stimuli would be moderately or highly painful (correct prediction), mildly painful (medium underprediction; Study 2 only), or non-painful (strong underprediction). Both studies showed that participants experienced less intense pain upon strong underprediction than upon correct prediction (i.e., assimilation). Expected pain, fear of pain, and pain unpleasantness were generally also lowered. However, strong underprediction simultaneously lowered certainty of expectations and trust in the experimenter. Study 2 indicated that the effects of strong underprediction versus medium underprediction generally did not differ. Moreover, Study 2 provided some indications for reduced heart rate and skin conductance levels, but increased skin conductance responses upon strong underprediction. In conclusion, even strong underpredictions of pain can reduce pain (i.e., cause assimilation), although not significantly more than medium underpredictions. However, strong underpredictions can cause uncertainty and undermine trust. These findings suggest that healthcare providers may wish to be cautious with providing overly positive information about painful medical procedures.

Effectiveness of Fully Immersive Virtual Reality as a Pain and Distress Treatment Method as Compared to Standard Analgesic Treatments in Children Undergoing Painful Medical Procedures: a Systematic Review. (Preprint)

BACKGROUND Effective pain and distress management remains a challenge for the paediatric population during medical procedures. Virtual Reality (VR) provides pain control by immersing an individual in a multisensory, 3-dimensional, computer-generated environment, offering a non-pharmacological way of pain reduction during invasive medical procedures. OBJECTIVE To assess the effectiveness of VR distraction as a pain control method compared to standard pharmacological and non-pharmacological methods. METHODS A SR of the literature used PsycINFO, PubMed, Ovid MEDLINE(R) and SCOPUS databases. Studies were included in the SR if they used an RCT design, were published in peer-reviewed, English language journals. Participants aged 3 to 21 years old had to undergo painful medical procedures in hospital settings with standard care as pain management in the control groups and VR distraction in the experimental groups. RESULTS 205 records were initially screened, ten papers underwent SR. Papers were assessed using the PEDro scale. VR demonstrated a statistically significant reduction in anxiety and pain in the experimental groups vs. control groups, with a large effect size -.90. Results showed a large heterogeneity between the studies and suggested that VR intervention was more effective in those clinical trials that utilised non-pharmacological pain relief methods as their standard method of care in control groups. CONCLUSIONS Overall, VR distraction was effective compared to standard non-pharmacological pain control methods and can be used during painful medical procedures to alleviate pain and anxiety in paediatric population.

Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures

Common medical procedures to assess and treat patients can cause significant pain and distress. Clinicians should have a basic approach for minimizing pain and distress in children, particularly for frequently used diagnostic and therapeutic procedures. This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures. Simple, evidence-based strategies for managing pain and distress are reviewed, with guidance for integrating them into clinical practice as an essential part of health care. Health professionals are encouraged to use minimally invasive approaches and, when painful procedures are unavoidable, to combine simple pain and distress-minimizing strategies to improve the patient, parent, and health care provider experience. Health administrators are encouraged to create institutional policies, improve education and access to guidelines, create child- and youth-friendly environments, ensure availability of appropriate staff, equipment and pharmacological agents, and perform quality audits to ensure pain management is optimal.

Children’s Fear and Pain During Medical Procedures: A Quality Improvement Study With a Humanoid Robot

Background Pediatric patients undergo a variety of painful medical procedures. Purpose The goal of this quality improvement study was to introduce a humanoid robot (MEDi®) programmed with strategies, such as distraction and deep breathing, at inpatient and outpatient units to determine any preliminary effects on children’s pain and fear during medical procedures. Methods A nonrandomized two-group pre- and posttest design was used to compare pain and fear of children before and after intervention versus standard care. A total of 46 children aged 2–15 years undergoing various medical procedures in a pediatric hospital, and their parents completed the Children’s Fear Scale and the Faces Pain Scale-Revised. The former was used both before and after the procedure, while the latter only after the procedure. Results Children ( n = 18), who interacted with the robot before and during a procedure, and their parents reported significantly lower levels of fear and pain than did children ( n = 28) and their parents in standard care, ps < .05. Conclusions The use of a humanoid robot programmed with psychological strategies to support coping may enhance children’s experiences of care for pain management.

Development of Cardiovascular Indices of Acute Pain Responding in Infants: A Systematic Review

Background. Cardiovascular indices of pain are pervasive in the hospital setting. However, no prospective research has examined the development of cardiac responses to acutely painful procedures in the first year of life.Objectives. Our main goal was to synthesize existing evidence regarding the development of cardiovascular responses to acutely painful medical procedures over the first year of life in preterm and term born infants.Methods. A systematic search retrieved 6994 articles to review against inclusion criteria. A total of 41 studies were included in the review.Results. In response to acutely painful procedures, most infants had an increase in mean heart rate (HR) that varied in magnitude both across and within gestational and postnatal ages. Research in the area of HR variability has been inconsistent, limiting conclusions.Conclusions. Longitudinal research is needed to further understand the inherent variability of cardiovascular pain responses across and within gestational and postnatal ages and the causes for the variability.