Background: Effective management of pain in children during painful procedures is a major priority for patients, parents and healthcare providers and is also a most important part of nursing care.
Objectives: This review was aimed at uncovering the best approach to effective management of pain control and focuses on procedural (transient or physiological) pain, mainly in diagnostic and therapeutic procedures.
Inclusion criteria: Types of participants
The participants in this study were pediatric patients suffering from all types of childhood cancer and were required to undergo painful procedures.
Types of intervention(s)
This review included both pharmacological and non-pharmacological pain management interventions for the pediatric population.
Types of studies
The review included any randomized controlled trials and non-randomized experimental trials related to procedural pain in children with cancer. Cohort studies with control group and case-controlled studies were also considered for inclusion.
Types of outcomes
The outcome of interest was the effectiveness of the intervention in managing procedural pain during the specific procedure. The main outcome was a change in pain levels measured using validated scales.
Search strategy: The review included a three-step search strategy for published and unpublished studies. Major databases searched included MEDLINE, CINAHL, EMBASE and MedNar from 1990-2013.
Methodological quality: The articles selected for retrieval were assessed by two independent reviewers for methodological validity using the standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument. Any disagreements were solved through discussions or with a third reviewer.
Data collection: Data was extracted using the standardized data extraction tools from the Joanna Briggs Institute. Data included specific details about authors, study design, population, management of procedural pain, validity and reliability of method used and type of scale.
Data synthesis: Due to the heterogeneity of included articles, statistical pooling was not possible and results were presented in a narrative summary.
Results: Eighteen articles were included in the review; thirteen on pharmacological interventions, three on non-pharmacological interventions and two on a combination of pharmacological and non-pharmacological interventions. The findings indicate that there are numerous articles on pain management during painful procedures in pediatric oncology settings. Various interventions were identified and compared; this review found that each study design was different, making comparison difficult. Hence this review could only report on the individual studies available and their outcomes.
Conclusion: In conclusion, each individual article may be valuable to the reader based on their geographical location and accessibility to interventions prescribed. Even though the findings suggest that deviation therapy may be better suited in children, there is no clear conclusion on the most effective pain management method. Therefore, more research on specific interventions and with crossover methodology should be carried out before any recommendations can be made.
Implications for practice: The method of pharmacological pain control should be via the patient's existing intravenous devices, or non-invasive methods, which will not induce added pain, discomfort or anxiety to the patient. Non-pharmacological interventions, such as music therapy, may be effective at reducing pain associated with some procedures and may be considered for use with pediatric oncology patients undergoing painful procedures.
Implications for research: A limitation of the review was the heterogeneity of patients, types of intervention, pharmacological agents prescribed, assessment tools, outcome measures and type of procedure discussed. Reducing this heterogeneity by implementing a set of standard research variables would greatly assist when comparing articles.