McMurtry C Meghan, Taddio Anna, Noel Melanie, Antony Martin M, Chambers Christine T, Asmundson Gordon J G, Pillai Riddell Rebecca, Shah Vibhuti, MacDonald Noni E, Rogers Jess, Bucci Lucie M, Mousmanis Patricia, Lang Eddy, Halperin Scott, Bowles Susan, Halpert Christine, Ipp Moshe, Rieder Michael J, Robson Kate, Uleryk Elizabeth, Votta Bleeker Elizabeth, Dubey Vinita, Hanrahan Anita, Lockett Donna, Scott Jeffrey
a Department of Psychology , University of Guelph , Guelph , Canada.
b Pediatric Chronic Pain Program, McMaster Children's Hospital , Hamilton , Canada.
Cogn Behav Ther. 2016 Apr;45(3):217-35. doi: 10.1080/16506073.2016.1157204. Epub 2016 Mar 23.
Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.
针头恐惧通常始于童年，是贯穿一生的一个重要的健康相关问题。高度惧怕针头的人常常回避医疗保健。尽管在医疗程序中存在管理针头疼痛和恐惧的指导意见，但最惧怕的人可能会拒绝或放弃此类程序。临床实践指南（CPG）的目的是就特定健康问题的管理提供可操作的指导；这种指导来自一个系统的过程。本CPG利用专家小组对严格系统评价的证据进行解读，就针对儿童和成人高度针头恐惧的基于暴露的干预措施提出建议。采用了AGREE-II、GRADE和Cochrane方法。纳入了基于暴露的干预措施。纳入的证据平均质量很低。强烈建议如下。对于7岁及以上的儿童和有高度针头恐惧的成人，建议采用基于现场（实际/亲自）暴露的疗法（与不治疗相比）。对于不愿接受现场暴露的个体（7岁以上），建议采用非现场（想象、基于计算机）暴露（与不治疗相比）。虽然没有纳入针对7岁以下儿童的试验，但基于暴露的干预措施作为良好的临床实践进行了讨论。讨论了实施方面的考虑因素并提供了临床工具。采用这些推荐的做法可能会因更好地遵守医疗保健规定而改善健康结果。迫切需要对高度针头恐惧的理解和治疗进行研究；提供了具体建议。
