title: The relationship between fear and pain levels during needle procedures in children from the parents' perspective.
abstract: BACKGROUND
  The primary objective was to determine the levels of and potential relationships between procedure-related fear and pain in children. Secondary objectives were to determine if there are associations between the child's age and sex, diagnostic group, time since diagnosis, time since last needle insertion, cortisol levels and the parent's fear level in relation to fear and pain.
  
  
  METHODS
  The child's level of pain and fear was reported by parents on 0-100 mm visual analogue scales (VAS). One hundred and fifty-one children were included consecutively when undergoing routine needle insertion into a subcutaneously implanted intravenous port. All children were subjected to one needle insertion following topical anaesthesia (EMLA) application. The effect of the child's age and sex, diagnostic group, time since diagnosis, time since last needle insertion, cortisol change levels and the parent's fear level, on fear and pain levels was investigated with multiple regression analysis.
  
  
  RESULTS
  The needle-related fear level (VAS mean 28 mm) was higher than the needle-related pain level (VAS mean 17 mm) when topical anaesthesia is used according to parents' reports (n = 151, p < 0.001). With fear as the dependent variable, age and pain were significantly associated and explained 33% of the variance, and with pain as the dependent variable, fear, parents' fear and change in cortisol level were significantly associated and explained 38% of the variance.
  
  
  CONCLUSIONS
  According to parents, children experienced more fear than pain during needle insertion when topical anaesthesia is used. Therefore, in addition to pain management, an extended focus on fear-reducing interventions is suggested for needle procedures.
authors.affiliation: Department of Women's and Children's Health, Pediatric Oncology, Uppsala University, Sweden.|School of Health Sciences, University of Borås, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Hedén
authors.affiliation: Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare, Uppsala University, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: von Essen
authors.affiliation: Department of Women's and Children's Health, Pediatric Oncology, Uppsala University, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Ljungman
mesh_terms: D002648:Child; D002675:Child, Preschool; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D007267:Injections / Q000523:psychology*; D008297:Male; D009339:Needles; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D010290:Parents / Q000523:psychology*