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Pain Pract. 2018 Jan;18(1):123-129. doi: 10.1111/papr.12572. Epub 2017 May 15.

Brief Clinical Report: A Systematic Review and Meta-analysis of Pain Memory-reframing Interventions for Children's Needle Procedures.

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Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
Department of Psychology, University of Guelph, Guelph, Ontario, Canada.
Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada.
Children's Health Research Institute, London, Ontario, Canada.
Department of Paediatrics, Western University, London, Ontario, Canada.
Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.



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.


adolescents; children; distress; fear; intervention; memory; needle; pain

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