The Cochrane Library and Procedural Pain in Children: An Overview of Reviews

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Procedural pain in children is highly prevalent, is a major source of pain, stress and anxiety for children and can have negative long-lasting effects. Research into effective pain prevention strategies is voluminous and complex, presenting challenges for clinically relevant synthesis.


To summarize Cochrane reviews assessing the effects of various interventions for pain in children undergoing painful medical procedures.


The Cochrane Database of Systematic Reviews was systematically searched for reviews on interventions for pain in children undergoing painful medical procedures. The type of data to be extracted was determined a priori, and data extraction was carried out by one author.

Main Results

Four systematic reviews were included in the overview. Two reviews assessed the effects of interventions on neonates, and two reviews assessed the effects of interventions on older children. Overall, the quality of the reviews was good.

Authors' Conclusions

Many convenient, safe and efficacious modalities for alleviation of paediatric procedural pain exist. Use of sucrose, breastfeeding or breast milk is effective and should always be offered for heel lance pain in neonates. These modalities are likely efficacious for other short painful procedures and may also be useful for older infants. Topical anaesthesia reduces needle pain. Amethocaine was found to be more effective with quicker onset of effect than EMLA, although new topical anaesthetics warrant attention. Behavioural therapies such as distraction are effective, inexpensive and can be used in conjunction with pharmacological analgesics without onerous resource use. Pain research is complex, and achieving consensus on the best methodological approaches will make imminent advances in this field more readily attainable.

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