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Abstract: This study assessed the relative efficacy of two imagery-based attentional strategies for modifying pain experience in children. Children aged 7–14 years () were randomly assigned to one of three conditions: distraction, sensory-focussing or control (no imagery). The distraction condition prompted children to focus their attention externally; the sensory-focussing condition prompted the child to focus internally on physical sensations. Self-report measures of pain coping style preferences and imagery ability were completed. Children''s pain tolerance and perceptions of pain intensity were assessed using a 10 °C cold-pressor task. Results showed pain intensity ratings after 1min were lower for both intervention conditions than for the controls. Younger children (7–9 years) showed higher pain tolerance in the distraction condition than in the sensory-focussing condition, whereas both interventions were equally effective for older children (10–14 years). Among older children, coping style interacted with the intervention type: in the sensory-focussing condition, pain tolerance was negatively associated with self-reported distraction-based coping style, whereas in the distraction condition this association was positive. The results are interpreted with reference to current models of attention. The implications for use of attentional strategies in helping children to cope with clinical pain are discussed. [Copyright &y& Elsevier]

Objective To summarize studies testing the efficacy and safety of single-dose acetaminophen and ibuprofen for treating children's pain or fever. Data Sources Reports were gathered by searching computerized databases (from their inception through May 2002) and registries, relevant journals, and bibliographies of key articles. Study Selection Seventeen blinded, randomized controlled trials with children (<18 years) receiving either drug to treat fever or moderate to severe pain. Data Extraction Under a fixed-effects model, outcome measures for an initial single dose of ibuprofen vs acetaminophen were the risk ratio for achieving more than 50% of maximum pain relief, effect size for febrile temperature reduction, and risk ratio for minor and major harm. Data Synthesis Ibuprofen (4-10 mg/kg) and acetaminophen (7-15 mg/kg) showed comparable efficacy (3 pain relief trials; 186 children). The risk ratio point estimates was 1.14 (95%confidence interval [CI], 0.82-1.58) at 2 hours after receiving the dose, and 1.11 (95% CI, 0.89-1.38) at 4 hours. Ibuprofen (5-10 mg/kg) reduced temperature more than acetaminophen (10-15 mg/kg) at 2, 4, and 6 hours after treatment (respective weighted-effect sizes: 0.19 [95% CI, 0.05-0.33], 0.31 [95% CI, 0.19-0.44], and 0.33 [95% CI, 0.19-0.47]) (9 fever trials; 1078 children). For ibuprofen 10 mg/kg (acetaminophen, 10-15 mg/kg), corresponding effect sizes were 0.34 (95% CI, 0.12-0.56), 0.81 (95% CI, 0.56-1.03), and 0.66 (95% CI, 0.44-0.87). There was no evidence the drugs differed from each other (or placebo) in incidence of minor or major harm (17 safety trials; 1820 children). Conclusions In children, single doses of ibuprofen (4-10 mg/kg) and acetaminophen (7-15 mg/kg) have similar efficacy for relieving moderate to severe pain, and similar safety as analgesics or antipyretics. Ibuprofen (5-10 mg/kg) was a more effective antipyretic than acetaminophen (10-15 mg/kg) at 2, 4, and 6 hours posttreatment. [ABSTRACT FROM AUTHOR]

Focuses on a study which investigated cognitive-behavioral predictors of children's tolerance for laboratory-induced cold-pressor pain. Profile of participants; Materials and measures; Procedure and analyses; Results and discussion.

In the past decade, interest in assessing and managing pain in children has increased. Nurses have helped implement routine pain measurement in clinical settings, including a campaign to make pain the fifth vital sign. However, clinicians may find it challenging to establish good pain-assessment practices in pediatric settings, since children can't always communicate their pain to clinicians in ways that can be reliably interpreted. Choosing a measurement tool appropriate to the population to be assessed is necessary if one is to obtain valid pain ratings.