Department of Plastic & Reconstructive Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Int Wound J. 2023 Sep;20(7):2898-2913. doi: 10.1111/iwj.14134. Epub 2023 Mar 1.
Pain is one of the complications associated with burns, which can lead to anxiety and sleeplessness in children. Various studies evaluated the effects of non-pharmacological interventions on burn wound care. The present study was conducted to determine the effects of non-pharmacological interventions on pain intensity of children with burns. A comprehensive systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Non-pharmacological', 'Virtual reality', 'Pain', 'Burn', 'Wound' and 'Child' from the earliest to December 1, 2022. The risk of bias in the final articles was also assessed with the Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Finally, a total of 1005 burn patients were included in 19 studies. The age range of the patients was from 0.5 to 19 years. Of the participants, 50.05% were in the intervention group. All studies had a randomised clinical trial design. The results found that non-pharmacological interventions significantly reduced pain intensity in children (ES: -0.73, 95% CI: -1.08 to -0.38, Z = 4.09, I :79.8, P < .001). Virtual reality (VR) (ES: -0.54, 95% CI: -1.19 to -0.18, Z = 2.90, I :72.9%, P = .004) and non-VR (ES: -0.86, 95% CI: -1.45 to -0.27, Z = 2.86, I :91.4%, P = .04) interventions decreased pain intensity significantly in children based sub-group analysis. Non-pharmacological interventions significantly reduced the pain intensity of dressing removal (ES: -0.77, 95% CI: -1.34 to -0.20, Z = 66.3, I :91.8%, P = .008), dressing application (ES: -0.53, 95% CI: -0.97 to -0.09, Z = 2.37, I :60.8%, P = .02), and physical therapy (ES: -1.18, 95% CI: -2.10 to -0.26, Z = 2.51, I :88.0%, P = .01). Also, interventions reduced the pain of burn wound care (ES: -0.29, 95% CI: -1.01 to 0.44, Z = 0.78, I :72.6%, P = .43), but it was statistically insignificant. In sum, the result of the present study indicated that using non-pharmacological interventions significantly reduced pain intensity in children. The reduction of pain intensity was greater in non-VR than in VR interventions. Future studies should focus on comparing VR interventions with non-VR and single versus multi-modal distraction to clarify the effectiveness of each.
疼痛是烧伤相关的并发症之一，可导致儿童焦虑和失眠。各种研究评估了非药物干预措施对烧伤伤口护理的影响。本研究旨在确定非药物干预措施对烧伤儿童疼痛强度的影响。综合系统检索了 Scopus、PubMed、Web of Science 等多个国际电子数据库，以及伊朗医学数据库（Iranmedex）和科学信息数据库（Scientific Information Database）等伊朗电子数据库，使用从最早到 2022 年 12 月 1 日从医学主题词中提取的关键字，如“非药物”、“虚拟现实”、“疼痛”、“烧伤”、“伤口”和“儿童”。最后还使用 Cochrane 随机临床试验偏倚风险工具（RoB 2）评估了最终文章的偏倚风险。最终，共有 19 项研究纳入了 1005 名烧伤患者。患者年龄范围为 0.5 至 19 岁。参与者中，50.05% 为干预组。所有研究均采用随机临床试验设计。结果发现，非药物干预措施可显著降低儿童的疼痛强度（ES：-0.73，95%CI：-1.08 至 -0.38，Z=4.09，I：79.8%，P<.001）。虚拟现实（VR）（ES：-0.54，95%CI：-1.19 至 -0.18，Z=2.90，I：72.9%，P=0.004）和非 VR（ES：-0.86，95%CI：-1.45 至 -0.27，Z=2.86，I：91.4%，P=0.04）干预措施可显著降低儿童的疼痛强度。基于亚组分析，非药物干预措施可显著降低换药（ES：-0.77，95%CI：-1.34 至 -0.20，Z=66.3，I：91.8%，P=0.008）、敷药（ES：-0.53，95%CI：-0.97 至 -0.09，Z=2.37，I：60.8%，P=0.02）和物理治疗（ES：-1.18，95%CI：-2.10 至 -0.26，Z=2.51，I：88.0%，P=0.01）的疼痛强度。此外，干预措施还可降低烧伤伤口护理的疼痛（ES：-0.29，95%CI：-1.01 至 0.44，Z=0.78，I：72.6%，P=0.43），但无统计学意义。总之，本研究结果表明，使用非药物干预措施可显著降低儿童的疼痛强度。非 VR 干预措施比 VR 干预措施更能降低疼痛强度。未来的研究应侧重于比较 VR 干预与非 VR 干预以及单一与多模态分散注意力，以明确每种干预措施的有效性。
