Non-Pharmacological Management of Burn-related Pain and Distress in Children: A Systematic Review and Meta-Analysis Study

Introduction: Pain and distress during burn-related painful procedures are common. Various non-pharmacological interventions are used to control pain and distress during burn-related painful procedures. Hereby, this study aimed to systematically review the recent literature regarding the efficacy of the non-pharmacological interventions to control pain perception and distress in children undergoing painful burn management procedures. Methods: the data sources were Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, and Science Direct databases were searched through 1989-2020. Data extraction was performed by two independent researchers. Selection criteria: Participants included children from birth to nineteen years. Only randomized controlled trials (RCTs) or RCT crossovers that had a no-treatment control comparison were eligible for inclusion in the analyses. Data analysis: The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Review Manager 5.4 software was used to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results: Out of 244 studies found, 15 trials met the inclusion criteria for further review with non-pharmacological interventions that included distraction (n=8), VR (n=5), hypnosis (n=1), and massage therapy (n=1). However, 13 trials out of 15 were included in the meta-analysis with 685 participants. Meta-analysis showed large effects of distraction intervention on self-reported pain (SMD -1.64, 95% CI -3.16, -0.12), observer-reported pain (SMD -3.02, 95% CI -5.85, -0.19), and behavioral distress (SMD -2.82, 95% CI -5.50, -0.14). Besides, distraction intervention showed moderate effects on self-reported distress (SMD -0.33, 95% CI -0.58, -0.08), and no effect on behavioral pain (SMD -1.06, 95% CI -2.44, 0.31). On the other hand, VR reported a large effect on self-reported pain (SMD 1.41, 95% CI -2.52, -0.30), a moderate effect on observer-reported pain (SMD -0.56, 95% CI -0.90, -0.22), and no effect on the behavioral pain (SMD -0.48, 95% CI -1.04, 0.08). Overall, the quality of derived evidence was downgraded due to study limitations, inconsistency, and imprecision. Conclusion: Distraction and VR are effective non-pharmacological interventions in reducing the pain perception and distress in children during painful burn management procedures.