Oliveira N C A C, Gaspardo C M, Linhares M B M
Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
Braz J Med Biol Res. 2017 Jul 3;50(7):e5984. doi: 10.1590/1414-431X20175984.
The aim of the present study was to systematically review the recent literature about pain and distress outcomes in children and critically analyze the methodological quality of the reports. The systematic review was based on the PRISMA statement and performed by selecting articles that are indexed in scientific databases. The methodological quality of reports was examined using STROBE statement, for observational studies, and CONSORT statement, for randomized controlled trials. The PedIMMPACT consensus was used to evaluate the psychometric quality of pain instruments. We analyzed 23 empirical studies, including 14 randomized controlled trials, seven cross-sectional studies, and two studies with cohort designs. Fourteen studies included preschool- and schoolchildren, and nine studies included infants. Regarding studies with infants, pain responses were evaluated by heart rate, crying and behavioral observation scales, and distress was evaluated only by salivary cortisol. Four-handed care and sensorial saturation interventions were used to evaluate efficacy to reduce pain and distress responses. Concerning studies with children, both pain and distress responses were evaluated by self- and hetero-reports, behavioral observation and/or physiological measures. Distraction was effective for reducing pain and distress during burn dressing changes and needle procedures, and healing touch intervention reduced distress and pain in chronic patients. All of the studies scored at least 60% in the methodological quality assessment. The pain outcomes included measures of validity that were classified as well-established by the PedIMMPACT. This systematic review gathers scientific evidence of distress-associated pain in children. Pain and distress were measured as distinct constructs, and their associations were poorly analyzed.
本研究的目的是系统回顾近期关于儿童疼痛和痛苦结局的文献，并批判性地分析报告的方法学质量。该系统评价基于PRISMA声明进行，通过选择科学数据库中索引的文章来开展。报告的方法学质量使用STROBE声明（用于观察性研究）和CONSORT声明（用于随机对照试验）进行检验。采用PedIMMPACT共识来评估疼痛测量工具的心理测量质量。我们分析了23项实证研究，包括14项随机对照试验、7项横断面研究和2项队列设计研究。14项研究纳入了学龄前儿童和学龄儿童，9项研究纳入了婴儿。关于婴儿的研究，通过心率、哭闹和行为观察量表评估疼痛反应，仅通过唾液皮质醇评估痛苦程度。采用四手操作护理和感觉饱和干预措施来评估减轻疼痛和痛苦反应的效果。关于儿童的研究，通过自我报告和他人报告、行为观察和/或生理测量来评估疼痛和痛苦反应。分散注意力在烧伤换药和打针过程中对减轻疼痛和痛苦有效，而治愈性触摸干预可减轻慢性病患者的痛苦和疼痛。所有研究在方法学质量评估中的得分至少为60%。疼痛结局包括PedIMMPACT分类为已确立的有效性测量指标。本系统评价收集了儿童痛苦相关疼痛的科学证据。疼痛和痛苦被作为不同的结构进行测量，对它们之间的关联分析不足。
