Effects of Distraction on Reducing Pain During Invasive Procedures in Children with Cancer: A Systematic Review and Meta-Analysis

Background: Distraction is a known behavioral intervention that is widely used for pain management in the pediatric population. However, there is a shortage of reviews reporting the efficacy of distraction for procedural pain reduction in pediatric oncology settings. Aim: To determine the current evidence on the effects of distraction on procedural pain in children with cancer. Design: This systematic review and meta-analysis was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines Settings: Six different databases from 1990 to June 2019. Method: A literature search was conducted to identify the effects of distraction on procedural pain reduction in children with cancer. A meta-analysis was undertaken along with applying a mixed effect model to quantify the standardized mean difference in the 95% confidence interval (CI) as the overall effects. Results: Ten randomized controlled trials were included. Distraction during an invasive procedure had a large effect on pain intensity (–0.92, 95% CI –1.48 to –0.36, p =.001) and on needle insertion as well (–1.12, 95% CI –1.52 to –0.72, p =.000), but only a moderate effect on lumbar puncture procedures (-0.57, 95% CI -1.02 to -0.12, p =.012). Uncertain effects on pain relief showed up in a virtual reality (VR) distraction (-0.93, 95% CI -2.63 to 0.76, p =.28) and during active distraction (-0.72, 95% CI -1.48 to 0.03, p =.06). Conclusions: Distraction is an efficacious intervention to reduce procedural pain during needle insertion or lumbar puncture procedures in children with cancer. However, the efficacy of active distraction and VR remain uncertain. Future research should focus on specific comparisons of different forms of distractions with larger sample sizes.