TABLE 3.

Systematic reviews with a quality rating less than 5

Reference, number of studies	Quality score	Focus	Main results
Rogers and Ostow 2004 (20), n=10	4	EMLA* cream compared with placebo (n=7), iontophoresis (n=2) and amethocaine cream (n=1) for venipuncture pain	EMLA* cream more effective than placebo. Inconclusive evidence regarding comparative efficacy of EMLA* and iontophoresis. No difference found between EMLA* and amethocaine cream. More side effects (erythema, pruritis and tingling) were observed with iontophoresis compared with EMLA*.
Taddio et al 2002 (21), n=8	4	Lidocaine-prilocaine (EMLA*) cream compared with amethocaine (tetracaine) gel for procedural pain (ie, intravenous cannulation, venipuncture and port-a-cath puncture)	Similar efficacy between lidocaine-prilocaine (60 min) and amethocaine (30 min) when used as labelled. Amethocaine more efficacious than lidocaine-prilocaine when applied for the same duration of time (40 min, 60 min, 2 h). Amethocaine commonly associated with erythema; lidocaine-prilocaine commonly associated with blanching.
Wild and Espie 2004 (23), n=9	4	Hypnosis in pediatric cancer patients to manage pain associated with medical procedures (ie, BMA, LP).	Inconclusive evidence regarding the efficacy of hypnosis due to methodological constraints of the primary studies (most failed to have appropriate control groups). Adverse events were not reported.

^*AstraZeneca Canada Inc. BMA Bone marrow aspiration; LP Lumbar puncture