Noel Melanie, McMurtry C Meghan, Pavlova Maria, Taddio Anna
Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
Department of Psychology, University of Guelph, Guelph, Ontario, Canada.
Pain Pract. 2018 Jan;18(1):123-129. doi: 10.1111/papr.12572. Epub 2017 May 15.
Children's pain memories play a powerful role in shaping future pain experiences. Interventions aiming to reframe children's memories of painful medical procedures hold promise for altering pain memories and improving subsequent pain experience; however, this evidence has not been synthesized. This brief clinical report includes a systematic review and meta-analysis of existing memory-reframing interventions for needle procedures in children and adolescents to stimulate future research.
Database searches identified relevant randomized and quasi-randomized controlled trials. Data were extracted and pooled using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and Cochrane methodologies. Critically important outcomes included fear during a subsequent needle procedure; important outcomes included memory of fear and pain following the needle procedure and pain and distress during a subsequent needle procedure.
Three studies including 158 children 3 to 18 years of age were identified. The quality of evidence was low to very low. There was no benefit for the critically important outcome of anticipatory fear; however, the test for overall effect trended toward significance (P = 0.07). Memory-reframing interventions were efficacious in altering children's memories of needle procedures to be less distressing. No benefit was found for acute fear or anticipatory, acute, or overall distress.
There are limited data suggesting that interventions that reframe children's memories of needle procedures hold promise for altering pain memories and potentially reducing anticipatory fear. High-quality intervention development work is needed to determine how these interventions can be adapted to the developing child in order to lead to lasting reductions in pain, fear, and distress at future needle procedures.
儿童的疼痛记忆在塑造未来的疼痛体验中起着重要作用。旨在重塑儿童对痛苦医疗程序记忆的干预措施有望改变疼痛记忆并改善后续的疼痛体验；然而，这方面的证据尚未得到综合。本简要临床报告包括对现有针对儿童和青少年针刺程序的记忆重塑干预措施的系统评价和荟萃分析，以推动未来的研究。
通过数据库检索确定相关的随机和半随机对照试验。使用推荐分级、评估、制定和评价（GRADE）以及Cochrane方法提取和汇总数据。至关重要的结果包括后续针刺程序期间的恐惧；重要结果包括针刺程序后对恐惧和疼痛的记忆以及后续针刺程序期间的疼痛和痛苦。
确定了三项研究，共158名3至18岁的儿童。证据质量低至极低。对于预期恐惧这一至关重要的结果没有益处；然而，总体效应检验有趋于显著的趋势（P = 0.07）。记忆重塑干预措施在改变儿童对针刺程序的记忆使其不那么痛苦方面是有效的。未发现对急性恐惧或预期、急性或总体痛苦有益处。
有限的数据表明，重塑儿童对针刺程序记忆的干预措施有望改变疼痛记忆并可能减少预期恐惧。需要开展高质量的干预措施开发工作，以确定如何使这些干预措施适应儿童的成长，从而在未来的针刺程序中持续减轻疼痛、恐惧和痛苦。
