Reframe the pain: Divided attention and positive memory reframing to reduce needle pain and distress in children—A feasibility randomized controlled trial

Felicity A. Braithwaite, Melanie Noel, Hannah G. Jones, Michael D. Wiese, Cara G. Nania, Emily Watson, Tasha R. Stanton

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Background: Negative experiences of needle procedures in childhood can lead to medical avoidance and vaccine hesitancy into adulthood. We evaluated the feasibility of two new interventions provided by clinical nurses to reduce the negative impact of vaccinations: divided attention (DA) and positive memory reframing (PMR). Methods: Children (8–12 years) were randomized into four groups: usual care (UC), DA, PMR or combined (DA + PMR). To evaluate feasibility, we undertook in-depth analysis of video-recorded interventions, nurse experiences (phone interviews) and child/parent memory recall of interventions (phone interviews at 2 weeks post-vaccination). Key clinical outcomes included child and parent ratings of needle-related pain intensity and fear assessed at baseline, immediately post-vaccination and 2 weeks post-vaccination (recalled). Results: A total of 54 child–parent dyads were screened, with 41 included (10/group, except PMR [n = 11]). The interventions were not always completed as intended: 10%–22% of participants received complete interventions and two had adverse events related to protocol breach. Preliminary within-group analyses showed no effects on child/parent pain ratings. However, children in DA + PMR had reduced recalled fear (p = 0.008), and PMR (p = 0.025) and DA + PMR (p = 0.003) had reduced fear of future needles. Parent ratings of child fear were also reduced immediately post-vaccination for UC (p = 0.035) and PMR (p = 0.035). Conclusions: The interventions were feasible, although enhanced nurse training is required to improve fidelity. Preliminary clinical results appear promising, particularly for reducing needle-related fear. Protocol registration: Protocol number ACTRN12618000687291 at Significance: Two new nurse-led interventions to reduce negative impacts of vaccinations in children, divided attention and positive memory reframing, were feasible and may reduce needle-related fear. Nurses were able to deliver the interventions in various environments including non-clinical settings (schools). These interventions have potential to facilitate broader dissemination of vaccinations for children in a manner that minimizes distress.

Original languageEnglish
Pages (from-to)1702-1722
Number of pages21
JournalEuropean Journal of Pain (United Kingdom)
Issue number8
Early online date7 Jun 2022
Publication statusPublished - 30 Sept 2022
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported via funding from the Australian Pain Society, Australian Pain Relief Association, Cops for Kids Clinical Research Grant (2018). T.R.S. is supported by a National Health & Medical Research Career Development Fellowship (ID1141735). F.A.B. is supported by the John Stuart Colville Fellowship (Arthritis Foundation of South Australia). Funding sources had no involvement in the conduct of the research or preparation of the article.

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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