Melanie Noel

Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents.

OBJECTIVE To systematically review the evidence (and quality) for distraction and hypnosis for needle-related pain and distress in children and adolescents. To explore the effects of distraction characteristics (e.g., adult involvement, type of distracter), child age, and study risk of bias on treatment efficacy.  METHODS 26 distraction and 7 hypnosis trials were included and self-report, observer-report, and behavioral pain intensity and distress examined. Distraction studies were coded for 4 intervention characteristics, and all studies coded for child age and study risk of bias.  RESULTS Findings showed strong support for distraction and hypnosis for reducing pain and distress from needle procedures. The quality of available evidence was low, however. Characteristics of distraction interventions, child age, and study risk of bias showed some influence on treatment efficacy. CONCLUSIONS Distraction and hypnosis are efficacious in reducing needle-related pain and distress in children. The quality of trials in this area needs to be improved.

The influence of children's pain memories on subsequent pain experience

Summary Children’s pain memories were a better predictor of subsequent pain reporting than initial reporting. Children with negatively estimated pain memories experienced increased pain over time. Abstract Healthy children are often required to repeatedly undergo painful medical procedures (eg, immunizations). Although memory is often implicated in children’s reactions to future pain, there is a dearth of research directly examining the relationship between the 2. The current study investigated the influence of children’s memories for a novel pain stimulus on their subsequent pain experience. One hundred ten healthy children (60 boys) between the ages of 8 and 12 years completed a laboratory pain task and provided pain ratings. Two weeks later, children provided pain ratings based on their memories as well as their expectancies about future pain. One month following the initial laboratory visit, children again completed the pain task and provided pain ratings. Results showed that children’s memory of pain intensity was a better predictor of subsequent pain reporting than their actual initial reporting of pain intensity, and mediated the relationship between initial and subsequent pain reporting. Children who had negatively estimated pain memories developed expectations of greater pain prior to a subsequent pain experience and showed greater increases in pain ratings over time than children who had accurate or positively estimated pain memories. These findings highlight the influence of pain memories on healthy children’s expectations of future pain and subsequent pain experiences and extend predictive models of subsequent pain reporting.

Pediatric Fear-Avoidance Model of Chronic Pain: Foundation, Application and Future Directions

The fear-avoidance model of chronic musculoskeletal pain has become an increasingly popular conceptualization of the processes and mechanisms through which acute pain can become chronic. Despite rapidly growing interest and research regarding the influence of fear-avoidance constructs on pain-related disability in children and adolescents, there have been no amendments to the model to account for unique aspects of pediatric chronic pain. A comprehensive understanding of the role of fear-avoidance in pediatric chronic pain necessitates understanding of both child⁄adolescent and parent factors implicated in its development and maintenance. The primary purpose of the present article is to propose an empirically-based pediatric fear-avoidance model of chronic pain that accounts for both child⁄adolescent and parent factors as well as their potential interactive effects. To accomplish this goal, the present article will define important fear-avoidance constructs, provide a summary of the general fear-avoidance model and review the growing empirical literature regarding the role of fear-avoidance constructs in pediatric chronic pain. Assessment and treatment options for children with chronic pain will also be described in the context of the proposed pediatric fear-avoidance model of chronic pain. Finally, avenues for future investigation will be proposed.

Children's Memory for Painful Procedures: The Relationship of Pain Intensity, Anxiety, and Adult Behaviors to Subsequent Recall

OBJECTIVE To examine whether childrens experience of pain intensity and anxiety, and adult behaviors during venepuncture, were related to childrens memories of the procedure. METHODS Participants were 48 children (24 males, 24 females) between the ages of 5 and 10 years who underwent venepuncture. The venepunctures were videotaped and adult behaviors were coded. Children self-reported their pain intensity and anxiety immediately and 2 weeks following venepuncture and answered contextual questions at follow-up. RESULTS Children who initially reported higher levels of pain tended to over-estimate their anxiety at follow-up, whereas children who reported lower levels of pain accurately- or under-estimated their anxiety. Staff coping-promoting behaviors predicted the accuracy of childrens contextual memories. Staff and parent behaviors did not predict childrens recalled pain intensity and anxiety. CONCLUSIONS Results indicate that childrens direct experience of pain intensity and staff behaviors during venepuncture are related to their memories. These data highlight the importance of effective pain management during medical procedures.

Children's fear during procedural pain: Preliminary investigation of the Children's Fear Scale.

UNLABELLED Many children consider getting a needle to be one of their most feared and painful experiences. Differentiating between a childs experience of fear and pain is critical to appropriate intervention. There is no gold standard one-item self-report measure of fear for use with children. OBJECTIVE To conduct an initial investigation of the psychometric properties of the Childrens Fear Scale (CFS; based on the adult Faces Anxiety Scale) with young school-age children. METHOD Children and their parents were filmed during venipuncture and completed pain and fear ratings immediately after the procedure (n = 100) and 2 weeks later (n = 48). Behavioral coding of the procedures was conducted. RESULTS Support was found for interrater reliability (Time 1: rs = .51, p < .001) and test-retest reliability (rs = .76, p < .001) of the CFS for measuring childrens fear during venipuncture. Assessment of construct validity revealed high concurrent convergent validity with another self-report measure of fear (Time 1: rs = .73, p < .001) and moderate discriminant validity (e.g., Time 1: rs = -.30, p < .005 with child coping behavior; rs = .41, p < .001 with child distress behavior). CONCLUSIONS The CFS holds promise for measuring pain-related fear in children. In addition to further investigation into the psychometric properties of the CFS during acute pain with a wider age range, future research could validate this measure in other contexts. The utility of a one-item measure of fear extends beyond the field of pediatric pain to other contexts including intervention for anxiety disorders and children in hospital.

Systematic Review and Meta-Analysis of Parent and Family-Based Interventions for Children and Adolescents With Chronic Medical Conditions

OBJECTIVE To quantify the effects of parent- and family-based psychological therapies for youth with common chronic medical conditions on parent and family outcomes (primary aim) and child outcomes (secondary aim). METHODS MEDLINE, EMBASE, and PsycINFO were searched from inception to April 2013. 37 randomized controlled trials were included. Quality of the evidence was evaluated using GRADE criteria. Data were extracted on parent, family, and child outcomes. RESULTS Pooled psychological therapies had a positive effect on parent behavior at posttreatment and follow-up; no significant improvement was observed for other outcome domains. Problem-solving therapy (PST) improved parent mental health and parent behavior at posttreatment and follow-up. There was insufficient evidence to evaluate cognitive-behavioral and systems therapies for many outcome domains. CONCLUSIONS Parent- and family-based psychological therapies can improve parent outcomes, with PST emerging as particularly promising. Future research should incorporate consensus statements for outcomes assessment, multisite recruitment, and active comparator conditions.

The relationship of parenting stress and child temperament to language development among economically disadvantaged preschoolers

Oral language skills in the preschool years are predictive of childrens later reading success and literacy acquisition, and among these language skills, vocabulary and narrative ability play important roles. Children from low socioeconomic families face risks to their language development and because of threats to these skills it is important to identify factors that promote their development among high-risk groups. This preliminary study explored two potential factors that may be related to language skills in 56 low SES mother-child dyads (children aged 2; 8-4; 10), namely child temperament and parenting stress. Results showed that child temperament and parenting stress were related to childrens oral language skills. Child temperament characteristics that would likely aid social interaction were related to narrative ability and children rated high on emotionality had poorer receptive vocabulary skills. Parenting stress was related to childrens receptive and expressive vocabulary skills. Results are interpreted in terms of the possible mediating role of parent-child interactions in childrens oral language skill development, and future directions for family intervention are discussed.

Reducing pain during vaccine injections: clinical practice guideline

Pain from vaccine injections is common, and concerns about pain contribute to vaccine hesitancy across the lifespan.[1][1],[2][2] Noncompliance with vaccination compromises the individual and community benefits of immunization by contributing to outbreaks of vaccine-preventable diseases. Individuals

The Role of State Anxiety in Children's Memories for Pain

OBJECTIVE To investigate the impact of experimentally manipulated state anxiety and the influence of anxiety-related variables on childrens memories for pain. METHODS A total of 110 children (60 boys) between the ages of 8 and 12 years were randomly assigned to complete a state anxiety induction task or a control task. Following experimental manipulation, children completed a laboratory pain task, pain ratings, and questionnaire measures of anxiety-related variables. 2 weeks later, children provided pain ratings based on their memories of the pain task. RESULTS The experimental manipulation effectively induced state anxiety; however, pain memories did not differ between groups. Irrespective of group assignment, children with higher state anxiety had more negative pain memories. State anxiety uniquely predicted childrens pain memories over and above other well established factors. Anxiety sensitivity and trait anxiety were significant predictors of recalled pain-related fear. CONCLUSIONS These data highlight the importance of anxiety in the development of childrens memories for pain.

Contemporary Use of the Cold Pressor Task in Pediatric Pain Research: A Systematic Review of Methods

UNLABELLED The cold pressor task (CPT) is an ethical experimental pain task widely used by pediatric pain researchers to examine a variety of important theoretical and clinical questions. The purpose of this systematic review was to describe contemporary use of the CPT in pediatric pain research to identify possible methodological and procedural inconsistencies and inform future research. All papers using the CPT to examine pain-related outcomes in children ≤18 years old published after 2005 were identified, 2005 being when published pediatric CPT studies were last reviewed and guidelines for pediatric use of the CPT were published. Information related to samples, CPT methodology, and pain outcomes was recorded. Thirty-six published papers, involving 2,242 children (aged 3-18 years) from both healthy and clinical samples, met review inclusion criteria. Several aspects of CPT methodology with significant potential to impact pain outcomes were found to be inconsistently implemented and reported, including water temperature, use of informed versus uninformed ceilings, and the presence of observers during the CPT. Self-report child pain intensity and pain tolerance were common outcomes. A number of refinements for use of the CPT in pediatric pain research are suggested. PERSPECTIVE The cold pressor task is a commonly used experimental method in pediatric pain research. This systematic review reveals important methodological inconsistencies in its use and suggestions for improvements to previously published guidelines.