Banca de DEFESA: ISABELE GOUVEIA MUNIZ DE ALENCAR

Non-pharmacological therapies for pain management in pediatric and neonatal intensive care units: a scoping review update

Pain Management; Pediatric Intensive Care
Units; Complementary Therapies; Music Therapy;
Music; Evidence-Based Nursing; Scoping Review.

MUNIZ, I.G. Non-pharmacological therapies for pain management in pediatric and neonatal intensive care units: a scoping review update. 2026, 145p. Thesis (Doctorate in Nursing in Health Care) — Health Sciences Center, Federal University of Rio Grande do Norte, Natal, 2026. Introduction: Pain in children admitted to Pediatric Intensive Care Units (PICU) is a complex and prevalent clinical phenomenon, even with established pharmacological protocols. Evidence on non-pharmacological therapies (NPTs) in this context remains fragmented and insufficiently systematized. Objective: To map the NPTs used in pain management in PICUs, identifying patterns, advances, gaps, and implications for evidence-based nursing practice. Method: Thesis structured in three stages: (1) scoping review protocol, registered in the Open Science Framework (DOI: 10.17605/OSF.IO/DZHKT) and published in BMJ Open (2024); (2) scoping review conducted using the JBI methodology, reported according to PRISMA-ScR, with searches in nine electronic databases (PubMed/MEDLINE, CINAHL, Embase, Scopus, Web of Science, LILACS, Academic Search Premier, ScienceDirect and Cochrane Library) and grey literature, without language restriction; and (3) updating of the scoping review. Data organized using the PAGER framework. Ethical aspects: Research with publicly available secondary data, exempt from review by a Research Ethics Committee (CNS Resolution No. 510/2016). Protocol registered prospectively. No conflict of interest. Main results: In the original review, 28 studies were included from 780 records; In the update, 56 studies from 1,002 records were included. Music-based interventions (recorded classical music, live music therapy, and recorded maternal voice) were the most frequent non-facial interventions (NFIs), with sessions lasting 10 to 60 minutes. Acupuncture, massage, therapeutic touch, aromatherapy, guided imagery, hypnosis, storytelling, virtual reality, positioning, and parental presence were also identified. Most studies reported a reduction in pain scores (FLACC, revised FLACC, COMFORT-B, Wong-Baker FACES, Numeric Rating Scale). Recurring limitations: Heterogeneity in protocols, lack of standardization of outcomes, small sample sizes, and co-administration of sedatives were identified. Evidence regarding mechanical ventilation and length of stay was inconclusive. PAGER analysis revealed underrepresentation of low- and middle-income countries, low integration of music therapy into care protocols, and critical conceptual heterogeneity: recorded music and live music therapy were grouped under the generic term "musical interventions," compromising the interpretability of the evidence. Conclusion: Music therapy is feasible and potentially beneficial as adjuncts to analgesia in PICUs. Robust clinical recommendations depend on methodological standardization and multicenter trials. The main contribution of this thesis is to make explicit the distinction between live music therapy and recorded music—non-interchangeable modalities whose grouping compromises the validity of evidence syntheses and clinical decision-making. Derivatives of the work: The protocol was published in BMJ Open (2024), ensuring traceability and reproducibility. This thesis strengthens the theoretical and practical framework of pediatric intensive care nursing, with applications to the NANDA-I (Acute Pain 00132; Impaired Comfort 00214; Anxiety 00146), NIC (Music Therapy 4400), and NOC (Pain Control 1605; Comfort Level 2100; Anxiety Level 1211) classifications. Social impact: The research aligns with SDG 3 (Health and Well-being) of the 2030 Agenda, particularly target 3.8. By mapping viable and low-cost family-centered nursing practices, it contributes to reducing the suffering of critically ill children in different socioeconomic contexts. The distinction between modalities of different complexity and cost favors the equitable adoption of these strategies. The findings reinforce the child's right to dignified and family-centered care and support the formulation of evidence-based care policies and protocols for pediatric intensive care.