Table 1.

Overview of Techniques to Prevent and Reduce Procedural Pain That May Be Used by Physiotherapists, with Selected References

Physical and Pharmacological

Cold—ice or cold packs, ice massage, contrast baths, vapocoolants63 Heat—hot packs, whirlpool, paraffin, fluidotherapy, infrared lamps63 Transcutaneous electrical nerve stimulation (TENS)65 Positioning for comfort—maximize contact with parent64 Touch—therapist maintains physical contact with the patient64 Positioning to maintain eye contact64 Massage38 For infants: oral sucrose59,60 Timing physiotherapy to coincide with peak effect of analgesic62,66 Bolus dose of analgesic complementing continuous analgesic infusion66

Psychological55

Preparatory information in age-appropriate language: sensory and procedural43–46,49,67 What is to be done Why it will be done What it will probably feel like (using non-threatening and positive terms) Calm tone of voice38,39 For infants: holding, rocking50,51 Providing some engagement in the procedure (e.g., having the patient count the seconds required to hold a stretch)38 Giving breaks from the procedure (contingent on task accomplishment, not pain expression)38 Diaphragmatic and other breathing exercises54,55 Using bubbles, party blowers, or pinwheels Using imagery—blowing up and deflating a balloon in the patient's stomach Progressive muscle relaxation38 Tensing phase is often not needed with children Use imagery with young children: robot then rag doll Distraction16,18,50–53 Singing to the patient Providing or encouraging patient to bring music to listen to via earphones Toys for the child to play with using parts of the body not involved in the procedure Guided or independent imagery: favourite place, favourite TV show Home practice of relaxation and imagery using audio recording of therapist's instructions Telling a story or jokes Television or video Virtual reality Coping skills training: teach child to select the best from some of the above strategies40,42 Positive self-talk: replace catastrophic thoughts with more positive ones57,58 Reinforcement by the therapist for successful coping57,58 Teaching children to recognize successful coping and praise themselves57,58 Relapse prevention: identify obstacles to coping in advance of the next procedure and discuss how they can be overcome57,58