Thirteen articles were included in the review: seven interventional studies (3 randomised controlled trials, 4 quasi-experimental studies), one qualitative ethological study and five cross-sectional descriptive studies.
The descriptive studies provided details of which non-pharmacological techniques were most frequently used in which situations, with two studies investigating barriers to the use of such techniques.
The qualitative study videotaped 17 children undergoing painful procedures. From the brief reporting of this study, it was stated that 'talking with' interactions appeared to have been the most effective in helping participants during painful situations, allied to the non-pharmacological technique of 'distraction'.
The results of the interventional studies were mixed. The most promising appeared to be those involving hypnosis in terms of reducing pain and anxiety, particularly with those children with high hypnotisability. One study that investigated art therapy found it be useful in helping children cope with painful procedures. Those studies not finding a statistically significant effect may in part reflect the fact that they were small and had methodological flaws, rather than that they investigated an ineffective intervention.