The Powerful Practice of Distraction

Jessika Boles, PhD, CCLS


Pediatr Nurs. 2018;44(5):247-249. 

In This Article

Abstract and Introduction


Conducting a literature search on "pain" is both an overwhelming and counterintuitive experience. As thousands upon thousands of articles, chapters, and scholarly sources appear, each reminds us of the same conceptual limitation of pain research: pain is a highly subjective, multi-dimensional construct that cannot be entirely or universally defined. There is some level of agreement on the structures and processes involved in a pain experience; however, because of its perceptual nature, there is no one-size-fits-all approach to the identification, diagnosis, and management of pain.

It is no secret that pain is not yet well controlled in pediatric patients (Stevens et al., 2012), especially those undergoing painful medical procedures (Taylor, Boyer, & Campbell, 2008). Some of these difficulties can be attributed to staff distress, practitioner competence, and barriers to resources or education (Olmstead, Scott, Mayan, Koop, & Reid, 2014). Yet other challenging factors may include systematic issues in health care or larger cultural philosophies about pain and suffering.

Melzack's (1999) gate control theory of pain is the most commonly studied theory in contemporary healthcare practice. According to gate control theory, pain signals must pass through a variety of control centers, or gates, in their journey to be interpreted and then felt as pain. However, each "gate" along the pathway can be opened or closed by other types of stimuli as well – not just pain. When these gates are closed by, for instance, focusing your thoughts on a different stimulus (i.e., your favorite song playing on the radio, reminding yourself to take deep breaths, or even composing your weekly grocery list), fewer pathways can be accessed by pain signals (Melzack, 1999). This is the power of distraction.

Distraction has recently become a popular non-pharmacological pain management technique in children's health care. Sometimes referred to as volition or alternative focus, distraction in this sense refers to "a relatively simple, yet effective, intervention for pain and distress associated with procedures that involves drawing attention away from the painful stimulus and onto a pleasurable diversion" (McCarthy et al., 2014, p. 398). Distraction can be delineated into active or passive types, depending on the level of engagement of the child. Active techniques require the child's cooperative involvement, whether by making choices, participating in conversation, or directing the distraction activity chosen. Passive techniques, on the other hand, may include listening to music, watching a video, or other distraction tools that need only passive engagement to function. Within each of these categories, there can be an endless supply of materials used; however, some have been more heavily researched than others.