Reducing procedural distress with non pharmacological interventions: an evaluation of efficacy in childwood

Iatrogenic pain, or procedure-related pain, is a multidemensional phenomenon, with physiological, sensory, affective, cognitive, behavioural as well as cultural dimensions.As reported by Rogers & Ostrow (2004), procedures involving needles, such as blood tests and intravenous injections are considered by children among the most painful events encountered during treatment (worst than post-surgical pain). Here we present an evaluation of efficacy of an intervention based on the use of humour by the professional staff of ‘Soccorso Clowns’ during venipucture procedures performed at the Day Hospital of the A.Meyer Hospital. 123 children, aged from 3 to 13 were assigned to the ‘Clown day’ or ‘No clown day’ by the direction of the Day Hospital (quasi-experimental design). The experimental group includes 63 children (33m and 30f). The Control group includes 64 children (36m and 28f). Distress was assessed with OBSB-a (Observational Scale for Behavioral Distress-amended) and Perceived Pain with VAS (Visual Analogue Scale) and AFS (Affective Face Scale). Coping style was evaluated on a subsample of 78 kids with a 6 items categorical scale, the ‘Active/Avoidant coping behavior measure’ (Pretzlik & Sylva, 1999) compiled during blood tests. Gender and Age have no influence on the distribution of the results in the Positive interaction scale (UMann-Whitney test, p>0.01) Active Coping was found to increase the level of positive interaction with clowns (UMann-Whitney =11.5, p<0.01) Gender and Coping style are independent categorical variables (2 test, p>0.05) In the blood tests situation, according to our results, the interaction with clowns strengthens the effect of an endogenous protective factor, such as active coping style.