Mu Pei-Fan, Chen Yu-Chih, Cheng Shu-Chen
1. School of Nursing, National Yang-Ming University, 2. Department of Nursing, Veteran General Hospital, Taipei, Taiwan R. O. C.
JBI Libr Syst Rev. 2009;7(34):1489-1543. doi: 10.11124/01938924-200907340-00001.
There is accumulating evidence that recurring pain symptoms in children are becoming a serious health concern. Children and adolescents who suffer from ongoing pain have negative outcomes not only to their physical health, but also to their emotional and spiritual health. Furthermore, recurrent pain in children may also cause a number of other negative consequences to the child, the family and society. Thus, a non-pharmacological approach to reduce the pain is vital to help children having better quality of life.
The objective of this review is to determine the best available evidence on the effectiveness of non-pharmacological pain management in relieving chronic pain for children and adolescents.
The search strategy aimed to find published studies, between 1956 and 2008 and limited to the English or Chinese languages. Reference lists of studies that met the inclusion criteria were searched for additional studies.
This review included any systematic reviews, randomized controlled trials and quasi-experimental design that explored the effectiveness of non-pharmacological intervention for chronic pain in children and adolescents.
Children and adolescents with cancer pain, Juvenile chronic arthritis, sickle cell disease, burn pain, chronic or recurrent abdominal pain, headache and aged 18 years old or less and suffering with pain for at least one month.
The review considered studies that examined non-pharmacological interventions in relieving chronic pain for children and adolescents that included heat wrap therapy, massage, chiropractic spinal manipulative therapy, cognitive-behavioral therapy (distraction & guided imagery), meditation, progressive muscle relaxation, self-hypnosis, biofeedback, music therapy, and dance training.
The primary outcome measures included: (1) Behavioral variables, such as pain behavior, cognitive coping and appraisal, psychiatric reaction (anxiety and depression), and social activities, (2) Quality of life scores and (3) Pain scores.
The review focuses on studies that operated either at a hospital or in a community setting.
Meta-analysis was used to pool the data from studies to determine the effectiveness of the intervention. The Comprehensive Meta Analysis V2 was used to manage the data.
The search process identified 43,100 studies that addressed the objectives of the review protocol. Fifty-four articles were selected for critical appraisal. Finally, 31 trials were considered to be eligible for the present review and 5 articles were excluded. Data was pooled together from eight articles using meta-analysis to examine the effectiveness of relaxation training of the pre-test and post-test of headache intensity. The findings show that the effective size was 0.323 with significant difference. Two of the articles evaluate the effectiveness of relaxation training for releasing the recurrent headaches for adolescents and the post-test data were collected over the following six months. The findings show that there is a statistically significance difference. Another two articles examined the effectiveness of a relaxation training program in reducing the sum of medication used of adolescents with recurrent headaches. The findings show that there is no statistical significance. Furthermore, the findings show that biofeedback treatment could improve the outcome of children and adolescents' headache, especially at 6 and 12 months after the treatment. In terms of psychosocial treatment, five articles examined the effectiveness of behavioral treatment, relaxation training program, cognitive behavior therapy, and acupuncture/ hypnosis intervention to reduce anxiety of children and adolescent with chronic pain. The various outcomes measures among the five studies.
This review has provided an evidence-based guide to future priorities for clinical practice. Relaxation programs could reduce recurrent headache and pain intensity in children and adolescents in the short term as well as lasting for three and six months. Furthermore, biofeedback treatment could reduce recurrent headache of pain intensity in children and adolescents in the short term and last for as long as six months.
越来越多的证据表明，儿童反复出现的疼痛症状正成为一个严重的健康问题。患有持续性疼痛的儿童和青少年不仅对其身体健康有负面影响，对其情绪和精神健康也有负面影响。此外，儿童反复疼痛还可能给儿童、家庭和社会带来许多其他负面后果。因此，采用非药物方法减轻疼痛对于帮助儿童提高生活质量至关重要。
本综述的目的是确定关于非药物疼痛管理对缓解儿童和青少年慢性疼痛有效性的最佳现有证据。
检索策略旨在查找1956年至2008年间发表的研究，且仅限于英文或中文。对符合纳入标准的研究的参考文献列表进行检索以查找其他研究。
本综述包括任何系统评价、随机对照试验和准实验设计，这些研究探讨了非药物干预对儿童和青少年慢性疼痛的有效性。
患有癌症疼痛、青少年慢性关节炎、镰状细胞病、烧伤疼痛、慢性或复发性腹痛、头痛且年龄在18岁及以下且疼痛持续至少一个月的儿童和青少年。
本综述考虑了研究非药物干预对缓解儿童和青少年慢性疼痛有效性的研究，这些干预包括热敷疗法、按摩、脊椎按摩疗法、认知行为疗法（分散注意力和引导式意象）、冥想、渐进性肌肉松弛、自我催眠、生物反馈、音乐疗法和舞蹈训练。
主要结局测量包括：（1）行为变量，如疼痛行为、认知应对和评估、精神反应（焦虑和抑郁）以及社交活动，（2）生活质量评分，（3）疼痛评分。
本综述重点关注在医院或社区环境中开展的研究。
采用荟萃分析汇总研究数据以确定干预的有效性。使用综合荟萃分析V2来管理数据。
检索过程共识别出43,100项涉及本综述方案目标的研究。54篇文章被选作批判性评价。最后，31项试验被认为符合本综述的要求，5篇文章被排除。使用荟萃分析对8篇文章的数据进行汇总，以检验放松训练对头痛强度的前后测效果。结果显示效应量为0.323，差异具有统计学意义。其中两篇文章评估了放松训练对缓解青少年复发性头痛的有效性，并在接下来的六个月内收集了后测数据。结果显示存在统计学显著差异。另外两篇文章研究了放松训练计划对减少复发性头痛青少年用药总量的有效性。结果显示无统计学意义。此外，结果表明生物反馈治疗可改善儿童和青少年头痛的结局，尤其是在治疗后6个月和12个月时。在心理社会治疗方面，5篇文章研究了行为治疗、放松训练计划、认知行为疗法以及针灸/催眠干预对减轻慢性疼痛儿童和青少年焦虑的有效性。五项研究中有各种结局测量。
本综述为未来临床实践的优先事项提供了循证指南。放松计划可在短期内减轻儿童和青少年的复发性头痛和疼痛强度，且可持续三到六个月。此外，生物反馈治疗可在短期内减轻儿童和青少年复发性头痛的疼痛强度，并可持续长达六个月。
