Search

Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the Childrens Comfort Promise, includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the Global Comfort Promise was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Childrens Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their childs pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.

Context: Heel prick is one among the common painful procedures in neonates. We performed a systematic review and network metaanalysis (NMA) to compare the efficacy of different interventions for analgesia during heel prick in neonates. Evidence acquisition: Medline, Cochrane, Embase and CINAHL databases were searched from inception until February 2023. Randomized and quasi-randomized trials that evaluated different pharmacological and non-pharmacological interventions for analgesia during heel prick for neonates were included. Data from the included trials were extracted in duplicate. A NMA with a frequentist random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. We adhered to the PRISMA-NMA guidelines. Results: One-hundred-and-three trials comparing 51 different analgesic measures were included. Among the 38 interventions, for pain "during" heel prick, non-nutritive suckling (NNS) plus sucrose [SMD Ȓ3.15 (Ȓ2.62, Ȓ3.69)], followed by breastfeeding, glucose, expressed breast milk (EBM), sucrose, NNS and touch massage, had a high certainty of evidence (CoE) to reduce pain scores when compared to no intervention. Among the 23 interventions for pain at 30 seconds after heel-prick, moderate CoE was noted for facilitated tucking plus NNS plus music, glucose, NNS plus sucrose, sucrose plus swaddling, mother holding, EBM, sucrose and NNS. Conclusions: Oral sucrose 2 minutes before combined with NNS during the procedure, was the best intervention for reducing pain during heel prick. It also effectively reduced pain scores 30 seconds and 1 minute after the procedure. Other interventions with moderate to high CoE for a significant reduction in pain during and at 30 seconds after heel prick are oral sucrose, oral glucose, EBM and NNS. All these are low-cost and feasible interventions for most of the settings. [ABSTRACT FROM AUTHOR]

Background: Managing pain and distress in children experiencing procedural pain is a priority in pediatric care. Nitrous oxide (pre-mixed formulation of 50% nitrous oxide to 50% oxygen) is widely used to alleviate anxiety or pain during care procedures in various medical domains. This pharmacological intervention is safe to administer to children. Administration by non-anesthesiologist personnel is widespread throughout the world, though it is almost exclusively performed by doctors and nurses. The purpose of this study is to describe the experience of nitrous oxide (N2O) use by medical assistants and safe handling during the performance of painful procedures. Methods: A retrospective study was conducted in a pediatric outpatient unit of a regional hospital, including medical and surgical consultations. Results: Nitrous oxide was administered by medical assistants to 324 children aged 3 to 19 years. No respiratory and/or cardiovascular problems were noted. Most patients were calm and relaxed. Discussion: The use of N2O for minor procedures in children in a pediatric outpatient unit improved pain management through administration by medical assistants with a high level of satisfaction from patients, parents and health professionals. Conclusions: This study suggests that the use of nitrous oxide by trained medical assistants can be safe, feasible and effective within the specific context of this study. [ABSTRACT FROM AUTHOR]

Aim Background Methods Results Conclusion Implications for the Profession and Patient Care Reporting Method Patient and Public Contribution To evaluate the impact of an eHealth educational resource about infant procedural pain management, given during the prenatal period, on feasibility, acceptability, knowledge, self‐efficacy, and involvement.Routine health care requires newborns to have painful procedures (e.g., intramuscular injection). The impacts of untreated pain in neonates are widely recognised but adoption of effective procedural pain management strategies in clinical practice varies. There is clear evidence supporting the effectiveness of parent‐led pain management during procedures (e.g., skin‐to‐skin care) and reputable resources to raise awareness among parents are warranted. Our team co‐created Parenting Pain Away, a website to equip parents with evidence to assist with managing the pain of procedures and empower them to be involved.A quasi‐experimental evaluation using a pre/post intervention design with low‐risk expectant parents.Of the 41 participants, before intervention exposure participants were familiar or had used skin‐to‐skin care (n = 33), breastfeeding (n = 30) and sucrose (n = 13) as pain management. Most participants (n = 38) desired more information on how to be involved. Providing access to Parenting Pain Away during pregnancy was supported and participants ranked the website above average using the System Usability Scale. Parenting Pain Away did not have a statistically significant influence on outcomes. Participants reported variation in clinical support with parent‐led pain management.A multifaceted approach is recommended to maintain infant procedural pain management.Equipping parents with knowledge related to infant pain management using an eHealth approach satisfied their information desires. The study findings are important considerations for perinatal care providers, policy makers, and families to finally achieve adequate procedural pain management.This study used the STROBE checklist, adhering to EQUATOR guidelines.A stakeholder group (expectant parents, parents, perinatal researchers, clinicians, and administrators) was created to inform the study design and intervention. [ABSTRACT FROM AUTHOR]

Introduction: There is an underuse of pain management strategies in dental care for children, possibly owing to perceived stress and discomfort when treating children, which has also been reported by dental students. The aim of this study was to explore how undergraduate dental students experience and understand pain related to dental treatment in children. Materials and Methods: Interviews were held with 21 Swedish dental students, from 3 dental schools, all in their final 2 years of education. The interviews were transcribed verbatim and analysed according to Grounded Theory. Results: A core category, seeking guidance to avoid pain, was identified and related to 6 conceptual categories. The students used different strategies to manage pain prevention in child dentistry and to become skilled dentists. They described high levels of stress, as well as having high expectations on themselves when treating children. The stress led to a surface learning approach, something the students were not fully aware of. Conclusion: All children should have the right to be ensured optimal pain prevention in dental care. The basis for this is laid during undergraduate education. Thus, pain management in child dentistry is an area in need of special attention in this respect. The academic staff has an important role in supporting their students in their process to gain an identity as professional dentists. To ensure that students incorporate an understanding of the importance of pain prevention when treating children there is a need to create more integration between theory and clinical training in undergraduate education. [ABSTRACT FROM AUTHOR]

The trial aimed to assess the impact on pain scores of the administration of oral glucose solutions at different concentrations and in combination with supportive positions during heel puncture procedures. This trial was structured as a quadruple-blinded experimental study conducted at a single center – a Level II and IVa NICU between June 2022–2023. Included in the study were 128 premature infants born with a gestational age of between 33 and 36 weeks and a postnatal age of <7 days. For the heel puncture procedures, four distinct interventions were employed, each involving supportive positions and oral solutions. All interventions were recorded on video for analysis, and data were collected using the "Infant Information and Observation Form" and "Neonatal Pain, Agitation and Sedation Scale (N-PASS)". The N-PASS was rated by two independent nurses. The data were analyzed with the two-way repeated measures ANOVA and post-hoc Bonferroni tests. The descriptive and clinical characteristics were similar in all groups (p > 0.05). The pain scores, physiological variables and total crying times of the premature infants differed significantly depending on the interventional groups and times, and the interaction between the groups and times (p < 0.05). Combining glucose solutions with supportive positions led to a reduction in pain scores, a decrease in total crying time when compared to the use of supportive positions alone. Combining an oral 20% glucose solution with supportive positions can be recommended to reduce pain during unplanned heel puncture procedures in the absence of a parent in the unit. • From the very first days of life, all infants experience procedural pain. • Effective pain management are integral to developmental care. • Ineffective management of pain has short- and long-term adverse consequences. • Combining oral glucose solutions with supportive positions can be effective in reducing pain responses. • Combining oral glucose solutions with supportive positions contributes to effective pain regulation. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions This study aims to investigate the effects of the white noise, swaddling and white noise + swaddling methods on pain and physiological parameters associated with orogastric tube insertion procedure.This was a randomized controlled trial. A total of 132 preterm infants were randomly assigned to four groups as white noise group (n = 33), swaddling group (n = 33), white noise + swaddling group (n = 33) and control group (n = 33). Interventions were initiated 5 min before the orogastric tube insertion procedure and continued during and up to 5 min after the procedure.White noise intervention alone did not have a significant effect on reducing pain associated with orogastric tube insertion (p > 0.05). Compared with the control group, the preterm infants in the swaddling group experienced 0.587 times less pain, and those in the white noise + swaddling group experienced 0.473 times less pain.Findings indicate the swaddling and the combination of white noise + swaddling may be a useful intervention in reducing the invasive pain experienced by preterm infants during and after orogastric tube insertion and in improving the physiological parameters associated with pain. [ABSTRACT FROM AUTHOR]

This study investigated the effect of a cognitive behavioural intervention package (CBIP) on peripheral venous cannulation (PVC) pain, fear and anxiety in paediatric patients aged 7–12 years. This randomised controlled trial included 77 paediatric patients (intervention: n = 39 and control: n = 38). The control group underwent a routine PVC procedure, whereas the intervention group attended the CBIP while undergoing a PVC procedure. Data were collected using a sociodemographic form, the Visual Analogue Scale (VAS), the Wong–Baker FACES (WB-FACES) Pain Rating Scale, the Children's Fear Scale (CFS) and the State–Trait Anxiety Inventory for Children–State Form (STAIC–State). The participants, their caregivers and the researcher scored PVC pain, fear and anxiety levels. The study was approved by an ethics committee. Informed consent was obtained from caregivers, and verbal consent was obtained from children. No significant difference in pre-procedural CFS scores were noted between the CBIP and control groups (p > 0.05). However, the CBIP group had significantly lower mean procedural pain (VAS and WB-FACES), fear (CFS) and anxiety (STAIC–State) scores than the control group (p < 0.05). The CBIP helped children experience less PVC pain, fear and anxiety. Nurses can use the CBIP to help reduce PVC pain, fear and anxiety in children. Clinical trials registration: The study was registered at Clinical-Trials.gov (NCT06018909). • The CBIP is an effective non-pharmacological method that can reduce procedural pain, fear and anxiety. • The CBIP can be safely used for PVC pain, fear and anxiety management in paediatric patients aged 7–12 years. [ABSTRACT FROM AUTHOR]

Despite advancements in pain management for burn injuries, analgesia often fails to meet our patients' needs. We hypothesized that low doses of intravenous (IV) ketamine as an adjunct to our current protocol would be safe, improving both nurse and patient satisfaction with analgesia during hydrotherapy. Burn patients admitted who underwent hydrotherapy from June 1, 2021, to June 30, 2023 were surveyed. Ketamine was administered with the standard opioid–midazolam regimen. Demographics, oral morphine equivalents, midazolam, ketamine doses and time of administration, and adverse events were collected. Patient and nurse satisfaction scores were collected. The ketamine and no-ketamine groups were compared. P <.05 was considered significant. Eighty-five hydrotherapies were surveyed, 47 without ketamine, and 38 with ketamine. Demographics, comorbidities, %TBSA, and hospital length of stay were not different. The median amount of ketamine given was 0.79 mg/kg [0.59-1.06]. Patients who received ketamine were more likely to receive midazolam (100% vs 61.7%; P <.001), and both oral and IV opioids (94.7% vs 68.1%; P =.002) prior to hydrotherapy and less likely to receive rescue opioids or midazolam during hydrotherapy. Two patients in the ketamine group had hypertension (defined as SBP > 180) that did not require treatment. Nurses tended to be more satisfied with patient pain control when ketamine was used (10 [8-10] vs 9 [7-10], P =.072). Patient satisfaction was higher in the ketamine group (10 [8.8-10] vs 9 [7-10], P =.006). Utilizing subhypnotic dose of IV ketamine for hydrotherapy is safe and associated with increased patient satisfaction. [ABSTRACT FROM AUTHOR]

Background In the post-operative period during the NICU stay, neonates must undergo various painful procedures. Non-pharmacological methods may be beneficial in managing the harmful effects of procedural pain on the development of neonates in their early life. Objectives To investigate the effect of non-pharmacological methods on post-operative procedural pain in neonates admitted to neonatal intensive care units. Methods A search in electronic databases was done to identify randomized clinical trials published from 2010 to 2020 that encompassed neonates undergoing painful procedures in the NICU and followed PRISMA guidelines. Studies with non-human subjects, neonates with unstable vital signs, non-clinical studies, and incomplete methodology were excluded. PubMed, Cochrane, and Physiotherapy Evidence Database (PEDro) were evaluated respectively using Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS). Results Two reviewers examined articles independently and found 11 articles that met the study's inclusion criteria, with a total of 955 neonates with non-pharmacological methods of pain management in neonates. Non-pharmacological methods, such as massage therapy, oral sucrose, kangaroo mother care, and facilitated tucking showed significant reduction in pain scores among neonates who underwent painful procedures in NICU. Outcomes showed variability in effectiveness, emphasizing the need for tailored approaches. Conclusions The findings indicated that non-pharmacological methods can effectively manage pain in neonates admitted to the NICU. Pain management improves the clinical condition of neonates and promotes parents-neonate bonding, with consequent reduction in length of stay in the hospital.

Introduction: Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents' vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills. Methods: In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research. Results: Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led painreducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent's and infant's needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals' attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants' procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change. Conclusion: Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cartoons are widely used distraction techniques for nonpharmacological management of procedural pain in pediatric settings. There are a few studies in the literature evaluate the effect of intervention on procedural pain, but a systematic review aimed at providing a summary of the overall effect is lacking. AIM: To summarize the available evidence on effectiveness of cartoons for children’s procedural pain. METHODS: Searching for parallel-group controlled trials was carried out on thirteen biomedical databases, five trial registries, web resources and gray literature sources from each database or resource setup date to 22 January 2023. Primary outcome was procedural pain, secondary outcome was anxiety. RoB 2 and ROBINS-I were used to assess risk of bias of included studies. RESULTS: 24 trials were selected for this review, which included a total of 3046 pediatric subjects. Children who watch cartoons during medical procedures experience less pain (SMD= -1.29; 95% CI: -1.75, -0.83; N=2239) and anxiety (UMD= -1.75; 95% CI: -2.94, -0.56; N=552) compared to children provided standard of care; for both outcomes, results are statistically significant. GRADE method shows moderate certainty/quality of evidence. CONCLUSIONS: Cartoons are more effective than standard of care in reducing procedural pain and anxiety in children. Pending future studies confirming the results, we recommend their implementation in daily clinical practice even in care settings with limited resources.

Abstract Background Patients with hematological malignancies received multiple hypodermic injections of recombinant human granulocyte colony-stimulating factor. Procedural pain is one of the most common iatrogenic causes of pain in patients with hematological malignancies. It is also identified as the most commonly occurring problem in clinical care in the Department of Hematology and Oncology at Shenzhen University General Hospital. However, providing immediate relief from pain induced by hypodermic injection of recombinant human granulocyte colony-stimulating factor remains a major challenge. This trial aims to evaluate the safety and analgesic efficacy of a fixed nitrous oxide/oxygen mixture for patients with hematological malignancies and experiencing procedural pain caused by hypodermic injection of recombinant human granulocyte colony-stimulating factor in the department. Methods The nitrous oxide/oxygen study is a single-center, randomized, double-blind, placebo-controlled trial involving patients with hematological malignancies who require hypodermic injections of recombinant human granulocyte colony-stimulating factor for treatment. This trial was conducted in the Hematology and Oncology Department of Shenzhen University General Hospital. A total of 54 eligible patients were randomly allocated to either the fixed nitrous oxide/oxygen mixture group (n = 36) or the oxygen group (n = 18). Neither the investigators nor the patients known about the randomization list and the nature of the gas mixture in each cylinder. Outcomes were monitored at the baseline (T0), immediately after hypodermic injection of recombinant human granulocyte colony-stimulating factor (T1), and 5 min after hypodermic injection of recombinant human granulocyte colony-stimulating factor (T2) for each group. The primary outcome measure was the score in the numerical rating scale corresponding to the highest level of pain experienced during hypodermic injection of recombinant human granulocyte colony-stimulating factor. Secondary outcomes included the fear of pain, anxiety score, four physiological parameters, adverse effects, total time of gas administration, satisfaction from both patients and nurses, and the acceptance of the patients. Discussion This study focused on the safety and analgesic efficacy during hypodermic injection of recombinant human granulocyte colony-stimulating factor procedure. Data on the feasibility and safety of nitrous oxide/oxygen therapy was provided if proven beneficial to patients with hematological malignancies during hypodermic injection of recombinant human granulocyte colony-stimulating factor and widely administered to patients with procedural pain in the department. Trial registration Chinese Clinical Trial Register, ChiCTR2200061507. Registered on June 27, 2022. http://www.chictr.org.cn/edit.aspx?pid=170573&htm=4

Background: Managing pain and distress in children experiencing procedural pain is a priority in pediatric care. Nitrous oxide (pre-mixed formulation of 50% nitrous oxide to 50% oxygen) is widely used to alleviate anxiety or pain during care procedures in various medical domains. This pharmacological intervention is safe to administer to children. Administration by non-anesthesiologist personnel is widespread throughout the world, though it is almost exclusively performed by doctors and nurses. The purpose of this study is to describe the experience of nitrous oxide (N2O) use by medical assistants and safe handling during the performance of painful procedures. Methods: A retrospective study was conducted in a pediatric outpatient unit of a regional hospital, including medical and surgical consultations. Results: Nitrous oxide was administered by medical assistants to 324 children aged 3 to 19 years. No respiratory and/or cardiovascular problems were noted. Most patients were calm and relaxed. Discussion: The use of N2O for minor procedures in children in a pediatric outpatient unit improved pain management through administration by medical assistants with a high level of satisfaction from patients, parents and health professionals. Conclusions: This study suggests that the use of nitrous oxide by trained medical assistants can be safe, feasible and effective within the specific context of this study.

Background: Patients with hematological malignancies received multiple hypodermic injections of recombinant human granulocyte colony-stimulating factor. Procedural pain is one of the most common iatrogenic causes of pain in patients with hematological malignancies. It is also identified as the most commonly occurring problem in clinical care in the Department of Hematology and Oncology at Shenzhen University General Hospital. However, providing immediate relief from pain induced by hypodermic injection of recombinant human granulocyte colony-stimulating factor remains a major challenge. This trial aims to evaluate the safety and analgesic efficacy of a fixed nitrous oxide/oxygen mixture for patients with hematological malignancies and experiencing procedural pain caused by hypodermic injection of recombinant human granulocyte colony-stimulating factor in the department. Methods: The nitrous oxide/oxygen study is a single-center, randomized, double-blind, placebo-controlled trial involving patients with hematological malignancies who require hypodermic injections of recombinant human granulocyte colony-stimulating factor for treatment. This trial was conducted in the Hematology and Oncology Department of Shenzhen University General Hospital. A total of 54 eligible patients were randomly allocated to either the fixed nitrous oxide/oxygen mixture group (n = 36) or the oxygen group (n = 18). Neither the investigators nor the patients known about the randomization list and the nature of the gas mixture in each cylinder. Outcomes were monitored at the baseline (T0), immediately after hypodermic injection of recombinant human granulocyte colony-stimulating factor (T1), and 5 min after hypodermic injection of recombinant human granulocyte colony-stimulating factor (T2) for each group. The primary outcome measure was the score in the numerical rating scale corresponding to the highest level of pain experienced during hypodermic injection of recombinant human granulocyte colony-stimulating factor. Secondary outcomes included the fear of pain, anxiety score, four physiological parameters, adverse effects, total time of gas administration, satisfaction from both patients and nurses, and the acceptance of the patients. Discussion: This study focused on the safety and analgesic efficacy during hypodermic injection of recombinant human granulocyte colony-stimulating factor procedure. Data on the feasibility and safety of nitrous oxide/oxygen therapy was provided if proven beneficial to patients with hematological malignancies during hypodermic injection of recombinant human granulocyte colony-stimulating factor and widely administered to patients with procedural pain in the department. Trial registration: Chinese Clinical Trial Register, ChiCTR2200061507. Registered on June 27, 2022. http://www.chictr.org.cn/edit.aspx?pid=170573&htm=4 [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background In the post-operative period during the NICU stay, neonates must undergo various painful procedures. Non-pharmacological methods may be beneficial in managing the harmful effects of procedural pain on the development of neonates in their early life. Objectives To investigate the effect of non-pharmacological methods on post-operative procedural pain in neonates admitted to neonatal intensive care units. Methods A search in electronic databases was done to identify randomized clinical trials published from 2010 to 2020 that encompassed neonates undergoing painful procedures in the NICU and followed PRISMA guidelines. Studies with non-human subjects, neonates with unstable vital signs, non-clinical studies, and incomplete methodology were excluded. PubMed, Cochrane, and Physiotherapy Evidence Database (PEDro) were evaluated respectively using Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS). Results Two reviewers examined articles independently and found 11 articles that met the study's inclusion criteria, with a total of 955 neonates with non-pharmacological methods of pain management in neonates. Non-pharmacological methods, such as massage therapy, oral sucrose, kangaroo mother care, and facilitated tucking showed significant reduction in pain scores among neonates who underwent painful procedures in NICU. Outcomes showed variability in effectiveness, emphasizing the need for tailored approaches. Conclusions The findings indicated that non-pharmacological methods can effectively manage pain in neonates admitted to the NICU. Pain management improves the clinical condition of neonates and promotes parents-neonate bonding, with consequent reduction in length of stay in the hospital. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Despite scientific advances, the management of procedural pain in neonates remains suboptimal. Applying adequate therapy to control pain during the neonatal period is a moral and ethical act. In recent decades, ample evidence has accumulated regarding the risks, associated with both untreated pain and the use of more aggressive analgesic therapy. Thus, the emphasis in neonatal clinical practice is on non-aggressive pain management techniques, including non-pharmacological methods, such as glucose and homeopathic agents. The efficacy and safety of homeopathic agents for reducing procedural pain in neonates is the subject of the present study. Materials and methods: Healthy full-term newborn babies with an average age of 72-84 hours were included. They were divided into three study groups: group (A) - without analgesia, (n = 67), group (B) - analgesic with Arnica D30 (n = 57) and group (C) - analgesic with Sol.Glucose 25% (n = 40). The severity of the pain was assessed using the multimodal - Neonatal Infant Pain Scale (NIPS) and the unimodal - Neonatal Facial Coding System (NFCS) scale. Assessments were done 30s before, 30 seconds after, and 5 minutes after the painful stimulus caused by the heel prick. Heart rate, transcutaneous oxygen saturation, respiratory rate and blood pressure were examined at the same intervals. The results obtained were processed statistically by descriptive analysis and ANOVA at a significance level of p < 0.05. Results: Five minutes after heel prick both scales showed a score near 3, i.e. no significant pain, and statistically significant lower score in those given Arnica D30, compared to those who received Sol.Glucose 25% (p < 0.05). When monitoring the physiological indicators, we found a significant increase in the heart rate 30 seconds after the procedure between group B and C. Five minutes after the heel prick we recorded significantly values of respiratory rate and systolic blood pressure in all three groups compared to accounted for pre-procedural values. Conclusion: Arnica D30 has better analgesic effects compared to Sol.Glucose 25% for newborn babies after heel prick tests. [ABSTRACT FROM AUTHOR]

Introduction: Cystometry is essential for evaluating bladder function. However, children may react negatively to the physical pain of urethral catheterization or anxiety and fear of an unfamiliar environment. These pain responses during the cystometry procedure may interfere with the cystometry procedure and make it difficult to interpret the cystometry result. In this regard, the International Children's Continence Society has advised performing cystometry while holding infants as an effective nonpharmacological pain management method, but there is insufficient evidence to support this. Purpose: This study aimed to analyze the effect of parental holding on reducing pain in children during cystometry. Methods: This was an experimental study in a randomized controlled pre–post test design. A total of 64 participants aged 6–18 months were recruited. During cystometry, the participants in the experimental group were placed on the parent's laps and held in the parents' arms. The participants in the control group were laid down on the examination table. During the procedure, both groups of parents were allowed to touch their children in all ways except holding them and to use the pacifier if they wished. The behavioral (face, leg, activity, cry, consolability scale) and physiological (oxygen saturation and heart rate) pain responses were measured at three‐time points (immediately, 3, and 10 min after urethral catheter insertion). Results: Comparing the two groups, in the experimental group, the behavioral pain response at 3 min after urethral catheter insertion (t = −2.165, p = 0.034) and 10 min after (t = −3.155, p = 0.002) was decreased compared with that immediately after urethral catheter insertion. In addition, oxygen saturation increased more (t = 2.021, p = 0.048), and the heart rate decreased more (t = −2.033, p = 0.047) at 10 min than at 3 min after urethral catheter insertion in the experimental group. Conclusions: This study revealed that parental holding could reduce pain responses during cystometry in children. Further research is required to confirm the applicability and usefulness of parental holding during cystometry. [ABSTRACT FROM AUTHOR]

This study was aimed to review Virtual Reality's (VR) impact on pain, anxiety, opioid usage, physiological and behavioural responses, and patients' experience during wound care (WC) in adults. We searched multiple databases (Embase, Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, Scopus and Google Scholar) from inception until January 27th, 2023. Included studies compared VR alone or as an adjunct to standard WC with standard WC or other distraction methods, in adults with burn or non‐burn‐related wounds. The risk of bias was assessed using the revised Cochrane risk‐of‐bias tool for randomised parallel‐group and crossover trials. The review followed PRISMA guidelines for reporting. Fourteen studies were eligible for inclusion. The meta‐analysis was limited to studies comprising solely of adult participants. VR reduced pain intensity compared to standard WC in all study designs. Despite not being included in the meta‐analysis due to reasons such as mixed population or lack of sufficient statistical data, other studies showed significant pain reduction using VR. Additionally, VR improved patients' experience of WC. No clear effect was found on other outcomes including anxiety, opioid usage and physiological and behavioural responses. VR shows promise in reducing acute pain and enhancing patients' experience of WC. The observed variations in the effects of VR at group and individual levels indicate the need for a personalised treatment plan by selecting the right VR for the right patient given at the right time. [ABSTRACT FROM AUTHOR]

IntroductionResearch related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents' vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills.MethodsIn this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research.ResultsParents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain-reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent's and infant's needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals' attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants' procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change.ConclusionParent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.

BackgroundThe present systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to investigate the effects of music on pain management in preterm neonates during painful procedures.MethodsThe PubMed, Embase, Web of Science, EBSCO and Cochrane Library databases were searched to identify relevant articles published from their inception to September 2023. The study search strategy and all other processes were implemented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsFour RCTs that satisfied the inclusion criteria were included in this meta-analysis. The music group had significantly lower Premature Infant Pain Profile (PIPP) scores during (RR = −1.21; 95% CI = −2.02–−0.40, p = 0.0032) and after painful procedures (RR = −0.65; 95% CI = −1.06–−0.23, p = 0.002). The music group showed fewer changes in PIPP scores after invasive operations than did the control group (RR = −2.06; 95% CI −3.16–−0.96; p = 0.0002). Moreover, our results showed that music improved oxygen saturation during (RR = 3.04, 95% CI = 1.64–4.44, p

Abstract Background Epidural labor analgesia is a safe and effective method of pain management during labor with the drawbacks of delayed onset and maternal distress during epidural puncture. This study aimed to determine whether pretreatment with intranasal low-dose dexmedetomidine effectively shortens the onset of analgesia and reduces procedural pain. Methods In this prospective, randomized double-blind trial, nulliparous patients were randomly assigned to either the intranasal dexmedetomidine group or the control group. The intranasal dexmedetomidine group received 0.5 μg/kg dexmedetomidine intranasally, and the control group received an equal volume of normal saline intranasally. Both groups were maintained with a programmed intermittent epidural bolus. The primary outcome was the onset time of analgesia and scores of pain related to the epidural puncture. Results Seventy-nine patients were enrolled, and 60 completed the study and were included in the analysis. The time to achieve adequate analgesia was significantly shorter in the intranasal dexmedetomidine group than in the control group (hazard ratio = 2.069; 95% CI, 2.187 to 3.606; P = 0.010). The visual analogue scale pain scores during epidural puncture in the intranasal dexmedetomidine group were also significantly lower than those in the control group (2.0 (1.8–2.5) vs. 3.5 (3.3–4.5), P ≤ 0.001, Table 2). Pretreatment with intranasal dexmedetomidine before epidural labor analgesia was associated with improved visual analogue scale pain scores and Ramsay scores, less consumption of analgesics and higher maternal satisfaction (P

BACKGROUND: In recent years, the use of virtual reality (VR) as a distraction technique for pain control in paediatric settings has become widespread. Despite the presence of several dedicated systematic reviews in the literature, none focus on the effectiveness of the intervention in the emergency room, a setting that is a source of great stress for children and caregivers. OBJECTIVE: To evaluate the effect of VR on the pain of children undergoing medical procedures in the emergency room. METHODS: Systematic review with meta-analysis of parallel-group randomised controlled clinical trials. Studies were retrieved by querying biomedical databases, online resources and trial registries. VR was compared with standard of care. The primary outcome was pain following the procedure. Risk of bias was assessed with RoB 2. The overall effect size was calculated with a random-effects model. The certainty/quality of the results was assessed with the GRADE approach. RESULTS: Six studies with 433 patients were included. The risk of bias is high for four studies and raises some concerns for two. Compared to standard of care, the use of VR had a small but statistically significant effect on pain (SMD: -0.32, 95% CI: -0.56, -0.09). Heterogeneity between studies was low. CONCLUSION: Virtual reality for pain in children undergoing medical procedures in the emergency room seems effective, but further studies are needed to confirm the results.

The objective of this study is to assess the effectiveness of non-immersive virtual reality as a pain-distraction measure in children between the ages of 3 and 5 years undergoing painful injection procedures in an outpatient setting. We carried out a randomized, unmasked clinical trial in children undergoing venipuncture or intramuscular injection procedures. Patients were randomized to a distraction virtual reality video or standard care. After the procedure, three independent observers (parents, researchers, nursing staff) rated pain on the LLANTO pain scale. We recruited 122 subjects, half of which were randomized to virtual reality. The median age was of approximately 60 months (IQR: 15 months), and the sample was balanced with regard to sex. There were significant differences in LLANTO scales scores between the VR subjects and controls of − 3.34 (95% CI − 4.15; − 2.54), − 3.02 (95% CI − 3.90; − 2.14), and − 2.98 (95% CI − 3.87; − 2.09), as rated by parents, researchers, and nursing staff, respectively. Agreement between raters was high for all three types of observers, with Cohen Kappas over 0.79 in all cases. Bivariate analysis showed reductions in the risk of obtaining higher scores in the LLANTO scale. Linear regression models showed a reduction of approximately 3 points in the scale, regardless of the type of observer. These models were adjusted for sex, age, kind of procedure, use of prior analgesia, and recruitment center. Conclusions: Non-immersive virtual reality is an effective adjunctive therapy for the reduction of pain in children undergoing painful injection procedures in an outpatient setting. This strategy may be used to improve the quality of care in pediatric outpatient services. Trial registration: ClinicalTrials.gov Identifier: NCT03985930 (Registered June 14, 2019). What is Known: •The use of immersive virtual reality (VR) has been described as an effective adjunctive distraction method during painful procedures in children over 5 years. What is New: •The utility of non-immersive VR in children below that age is not yet clear. This randomized clinical trial comparing non-immersive VR vs. standard care showed an average reduction of three points in the LLANTO pain scale favoring non-immersive VR. Non-immersive VR is an effective and inexpensive non-pharmacological technique that reduces fear and pain in pediatric patients. [ABSTRACT FROM AUTHOR]

Repeated procedural pain can cause preterm infants to spend excessive time awake at the cost of sleep and can have a detrimental impact on later cognitive and behavioral development. What’s more, poor sleep may be correlated with worse cognitive development and more internalizing behaviors in infants and toddlers. In a randomized controlled trial (RCT), we found that combined procedural pain interventions (sucrose, massage, music, nonnutritive sucking, and gentle human touch) during neonatal intensive care could improve preterm infants’ early neurobehavioral development. Here, we followed up the participants who were enrolled in the RCT to evaluate the effect of combined pain interventions on later sleep, cognitive development, and internalizing behavior and to determine whether sleep may moderate the effect of combined pain interventions on the cognitive development and internalizing behavior. Total sleep time and night awakenings at 3, 6, and 12 months old; the cognitive development (adaptability, gross motor, fine motor, language, and personal–social domains) at 12 and 24 months old measured by the Chinese version of Gesell Development Scale; and the internalizing behavior at 24 months old measured by the Chinese version of Child Behavior Checklist were assessed. Our findings showed the potential benefits of combined pain interventions during neonatal intensive care for preterm infant’s later sleep, motor and language development, and internalizing behavior, and the effect of combined pain interventions on motor development and internalizing behavior might be moderated by the mean total sleep duration and night awakenings at 3, 6, and 12 months old. [ABSTRACT FROM AUTHOR]

The pain experienced during Pap tests is a crucial gap in reducing cervical cancer burden. This study sought to investigate whether adding a nonpainful step at the end of Pap tests helps women recall less pain. We conducted a randomized controlled trial on women aged 30 to 70 years at a cervical cancer screening center. A nonpainful step was added at the end of Pap test in the modified Pap group. The outcomes included recalled pain after Pap smear screening, real-time pain, and 1-year willingness to receive further Pap tests. Among 266 subjects in the intention-to-treat analysis, the modified Pap group (n = 133) experienced lower 5-minute recalled pain than the traditional Pap group on a 1 to 5 numeric scale (mean [SD], 1.50 [0.77] vs 2.02 [1.12]; P < 0.001) and a 0 to 10 visual analog scale (2.12 [1.79] vs 3.12 [2.23]; P < 0.001). In exploratory subgroup analyses, the association between the modified Pap test and reduced 5-minute recalled pain was not affected by predicted pain, demographic, or socioeconomic characteristics, but it was more apparent in postmenopausal women. Consistently, the modified Pap test attenuated 1-year recalled pain on both pain scales. Furthermore, the modified Pap test increased 1-year willingness grade to receive further Pap tests (adjusted β [SE], 2.11 [0.27]; P < 0.001). In conclusion, adding a nonpainful step at the end of Pap smear screening reduces on-site and long-term recalled pain and strengthens willingness to undergo subsequent Pap tests regularly. The modified Pap test contributes to cervical cancer screening participation. [ABSTRACT FROM AUTHOR]

Aim: To present the development, evaluation and adaptation of the PAIN‐Neo theory. Design: Theory development. Data Sources: A review of literature was conduct from 1980 to 2021. Results: Using a critical realism paradigm, this paper presents the PAIN‐Neo theory, which was developed from an analysis of existing theoretical perspectives on paediatric procedural pain, empirical studies conducted with preterm infants, and the research team's pain management expertise. The theory was then empirically tested and fine‐tuned. Implications for Nursing: The PAIN‐Neo theory highlights that the neonatal nurse is part of a larger picture as she is influenced by factors related to her unit, hospital and country of practice. This theory emphasizes the importance of parental involvement in pain management, which is consistent with family‐centred nursing practices. Conclusion: The PAIN‐Neo theory reflects the complexity of pain management nursing. This theory is innovative and specific enough to guide practice, structure research projects and contribute to the body of knowledge in the discipline of nursing. [ABSTRACT FROM AUTHOR]

Objective Pain and distress are common in children undergoing medical procedures, exposing them to acute and chronic biopsychosocial impairments if inadequately treated. Clinical hypnosis has emerged as a potentially beneficial treatment for children's procedural pain and distress due to evidence of effectiveness and potential superiority to other psychological interventions. However, systematic reviews of clinical hypnosis for children's procedural pain and distress have been predominantly conducted in children undergoing oncology and needle procedures and are lacking in broader pediatric contexts. This scoping review maps the evidence of clinical hypnosis for children's procedural pain and distress across broad pediatric contexts while highlighting knowledge gaps and areas requiring further investigation. Methods Published databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus, and Web of Science) and grey literature were searched in addition to hand-searching reference lists and key journals (up to May 2022). Two independent reviewers screened the titles and abstracts of search results followed by a full-text review against eligibility criteria. Articles were included if they involved a clinical hypnosis intervention comprising an induction followed by therapeutic suggestions for pain and distress in children undergoing medical procedures. This review followed the Arksey and O'Malley (2005) methodology and incorporated additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results A total of 38 eligible studies involving 2,205 children were included after 4,775 articles were screened. Research on clinical hypnosis for children's procedural pain and distress was marked by a lack of fidelity measures and qualitative data as well as by inadequate intervention reporting and high attrition rates. Evidence regarding the safety of clinical hypnosis, pain unpleasantness outcomes, factors influencing outcomes, as well as barriers and facilitators to implementing hypnosis and study procedures was also lacking. Clinical hypnosis has potential benefits for children's procedural pain and distress based on evidence of superiority to control conditions and nonpharmacological interventions (e.g. distraction, acupressure) with moderate to large effect sizes as reported in 76% of studies. However, heterogeneous interventions, contexts, study designs, and populations were identified, and the certainty of the evidence was not evaluated. Conclusions The review suggests potential benefits of clinical hypnosis for children's procedural pain and distress and thus provides a precursor for further systematic reviews and trials investigating the effectiveness of clinical hypnosis. The review also indicates the need to further explore the feasibility, acceptability, implementation, and safety of clinical hypnosis in children undergoing painful procedures. Based on the review, researchers implementing clinical hypnosis should adequately report interventions or use treatment manuals, follow recommended research guidelines, and assess the fidelity of intervention delivery to promote replicating and comparing interventions. The review also highlights common methodological shortcomings of published trials to avoid, such as the lack of implementation frameworks, small sample sizes, inadequate reporting of standard care or control conditions, and limited evidence on pain unpleasantness outcomes. [ABSTRACT FROM AUTHOR]

Background: Epidural labor analgesia is a safe and effective method of pain management during labor with the drawbacks of delayed onset and maternal distress during epidural puncture. This study aimed to determine whether pretreatment with intranasal low-dose dexmedetomidine effectively shortens the onset of analgesia and reduces procedural pain. Methods: In this prospective, randomized double-blind trial, nulliparous patients were randomly assigned to either the intranasal dexmedetomidine group or the control group. The intranasal dexmedetomidine group received 0.5 μg/kg dexmedetomidine intranasally, and the control group received an equal volume of normal saline intranasally. Both groups were maintained with a programmed intermittent epidural bolus. The primary outcome was the onset time of analgesia and scores of pain related to the epidural puncture. Results: Seventy-nine patients were enrolled, and 60 completed the study and were included in the analysis. The time to achieve adequate analgesia was significantly shorter in the intranasal dexmedetomidine group than in the control group (hazard ratio = 2.069; 95% CI, 2.187 to 3.606; P = 0.010). The visual analogue scale pain scores during epidural puncture in the intranasal dexmedetomidine group were also significantly lower than those in the control group (2.0 (1.8–2.5) vs. 3.5 (3.3–4.5), P ≤ 0.001, Table 2). Pretreatment with intranasal dexmedetomidine before epidural labor analgesia was associated with improved visual analogue scale pain scores and Ramsay scores, less consumption of analgesics and higher maternal satisfaction (P < 0.05). No differences were observed for labor and neonatal outcomes or the incidence of adverse effects between the two groups. Conclusions: Pretreatment with intranasal dexmedetomidine before epidural labor analgesia yielded a faster onset of analgesia and decreased epidural puncture pain without increasing adverse effects. Pretreatment with intranasal dexmedetomidine may be a useful adjunct for the initiation of epidural analgesia, and further investigation should be encouraged to determine its utility more fully. Trial registration: This trial was prospectively registered at Chictr.org.cn on 29/05/2020 with the registration number ChiCTR2000033356 (http://www.chictr.org.cn/listbycreater.aspx). [ABSTRACT FROM AUTHOR]

Pain experiences can negatively impact children and adolescents, leading to trauma symptoms and nonadherence to important health behaviors. Developmentally-tailored communication strategies may mitigate this risk. This article reviews cognitive and linguistic developmental factors, within the familial and cultural context, that are important to consider when communicating with youth about acute, procedural, and/or chronic pain. Youth undergoing acute or procedural pain benefit from pain education, truthful information about the procedure, and advance preparation. The use of analogies may be particularly helpful for patient understanding of chronic pain development, maintenance, and treatment. Youth with developmental disabilities may express pain differently than their normative peers, requiring adaptation of communication strategies. Developmentally-tailored pain communication is an important tool for caregivers and healthcare providers that may foster adaptive functioning in youth who experience pain.

Resumen: Introducción: El monitor NIPE (Newborn Infant Parasympathetic Evaluation) es una herramienta rápida, continua y objetiva de evaluación del disconfort neonatal. Los objetivos fueron describir los cambios del NIPE tras una extracción sanguínea y los factores implicados en su variación. Material y métodos: Estudio observacional analítico con recogida de datos prospectiva. Se incluyeron los recién nacidos ingresados en cuidados intensivos entre junio y diciembre de 2021 a quienes se les realizó extracción sanguínea. Se recogieron variables demográficas, las relacionadas con la realización del procedimiento, la puntuación NIPE, la frecuencia cardiaca previa y en los minutos 1, 2, 3, 4, 5, 10 y 15 posteriores. Resultados: Se incluyeron 86 registros de 49 pacientes. Durante los primeros cuatro minutos tras el procedimiento hubo un descenso significativo en la puntuación NIPE, siendo el descenso máximo de un 22,8% respecto al valor basal, produciéndose el nadir a los 2,79 minutos. El mayor descenso del NIPE ocurrió en pacientes prematuros, varones, con menor Apgar a los cinco minutos, en procedimientos ya realizados previamente, tras cesárea y en horario matutino. No hubo diferencias con la realización en canguro. La correlación entre NIPE y frecuencia cardíaca fue débil. Conclusiones: Tras un procedimiento doloroso, como una extracción sanguínea, el monitor NIPE mostró un descenso significativo los primeros cuatro minutos, agudizándose el descenso con la prematuridad, la reiteración de procedimientos o el nacimiento tras cesárea. El monitor NIPE puede ayudar a identificar eficazmente a aquellos neonatos que sufren dolor agudo tras un procedimiento, complementándose con las escalas de valoración clínica. Abstract: Introduction: The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. Material and methods: We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15 min after the procedure. Results: The study included 86 records for 49 patients. In the first 4 min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79 min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. Conclusions: After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4 min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales.

Aim: This study aims to characterise current pain management practices in extremely preterm infants (gestational age less than or equal to 28 weeks) admitted to neonatal intensive care unit (NICU). Methods: Retrospective audit pertaining to patient characteristics, as well as minor painful procedures (MPP), pain mitigation and pain scoring in 25 extremely preterm infants admitted to a tertiary NICU in 2016 over the first 14 days of NICU admission. Opportunities to bundle MPP were identified according to pre‐specified criteria. Bayley Scales of Infant Development, Third Edition (BSID‐III) cognitive, language and motor composite scores were available from the neurodevelopmental follow‐up clinic at 12‐ and 24‐months of corrected age. Linear mixed methods regression was used to examine for correlation between increased exposure to MPP and BSID‐III scores at follow‐up. Results: Extremely preterm infants underwent an average of 11.24 ± 4.12 MPP per day for the first 14 days of NICU admission. Opportunities to bundle MPP were missed 75.98% (408/537) of the time; most of these were invasive blood collections. A total of 12.2% (481/3933) of MPP occurred within 4 h of pharmacological or non‐pharmacological pain mitigation. BSID‐III motor composite score was associated with an 11.75 (95% confidence interval 1.99, 21.27) decrease in patients experiencing more than or equal to the third quartile of MPP in the 14 days post‐NICU admission (P = 0.0329, n = 42). Association was not found for BSID‐III cognitive and language composite scores. Conclusions: There is readily scope for quality improvement initiatives to reduce harm in extremely preterm infants admitted to NICU. [ABSTRACT FROM AUTHOR]

Introduction: Pain is the most common symptom after the first activation of orthodontic appliance. The most widely used analgesic treatment is paracetamol; however, its use inhibits cyclooxygenase activity and prostaglandin synthesis, which can affect the mechanism of tooth movement and bone remodeling. Objective: To evaluate the effectiveness of low power laser for pain relief in patients with orthodontic treatment. Methods: A quasi-experimental study of therapeutic intervention was carried out, from January to December 2020, in 40 patients treated at the orthodontic clinic of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, in whom orthodontic force was applied for the first time. These were randomly distributed into 2 groups of 20 members each: the study group, treated with low-power laser, and the control group, that received conventional medication (paracetamol). For statistical validation of data, the percentage and the Student's t test for independent samples were used, with 95 % confidence interval. Results: After three therapeutic sessions, 90.0% of the study group reported not presenting pain or feeling it slightly, while only 10.0% of patients in control group were put in any of the two previous categories. There was a significant difference between both groups (p=0.00). Conclusions: Laser, as an alternative therapy, was shown to be more effective than paracetamol. [ABSTRACT FROM AUTHOR]

Breakthrough pain (BP) is a complex phenomenon that has been reported to have a relevant role in the global management of cancer pain. Radiotherapy (RT) has a fundamental part in the treatment of many pain conditions, particularly oral mucositis and painful bone metastases. The literature regarding the phenomenon of BP in the radiotherapy setting was reviewed. Three areas were assessed, including epidemiology, pharmacokinetics, and clinical data. Qualitative and quantitative data regarding BP in the RT setting are poor in terms of scientific evidence. Most papers assessed fentanyl products, particularly fentanyl pectin nasal spray, to resolve possible problems with transmucosal absorption of fentanyl due to mucositis of the oral cavity in patients with head and neck cancer or to prevent and treat procedural pain during RT sessions. According to the lack of clinical studies with large number of patients, BP should be included in the agenda of radiation oncologists. [ABSTRACT FROM AUTHOR]

Aims The study aimed to determine the effect of using a crochet octopus to reduce acute pain and maintain optimal physiological measurements that develops during procedural pain in neonates. Materials and methods This was a parallel design randomized controlled study. During the procedure of heel lance, experimental groups were delivered a crochet octopus 10 min before the process and let them touch the octopus during and for up to 10 min after the procedure. Control group experienced the process without any intervention. SpO2, duration of crying of neonates and pain they experienced were evaluated. Results The study was completed with 100 (50 for the experimental group and 50 for the control group) term neonates. SpO2 of neonates, touching the crochet octopus during and after in second minute of the process was found higher and also the duration of crying was shorter during whole the process, and the pain they experienced due to the process was lower than the control group. Conclusions Crochet octopus affected physiological measurements of the neonates positively and reduced the procedural pain as well. [ABSTRACT FROM AUTHOR]

Objective: Exposure to painful stimuli serves as toxic stress for infants, increasing their subsequent pain sensitivity and resulting in neurodevelopmental impairments. Besides offering nutritional, psychological, immunological, and economic benefits, breastfeeding is reported as the most effective analgesia for the management of minor procedural pain in infants. Although breastfeeding holds several advantages, implementation of this nonpharmacological intervention is still uncommon in many clinical settings. Methods: This scoping review presents an analysis of 29 clinical trials that compare the effectiveness of breastfeeding with other nonpharmacological methods. Findings: Breastfeeding is an efficacious analgesia compared with sucrose, sweet solutions, and other nonpharmacological methods. When used alone or in combination with other nonpharmacological interventions, breastfeeding reduces infants' biobehavioral responses to pain and promotes faster physiologic recovery after painful procedures. Breastfeeding is recommended as the first choice whenever feasible. Barriers to the uptake of this effective pain management method in clinical practice include misinformation/inconsistent use of evidence, an infant's impaired sucking reflex, maternal–child separation, the workload of healthcare professionals, a lack of parental involvement, assumptions of healthcare providers, and a lack of adequate information/guidance for parents. Strategies to promote the uptake of breastfeeding for the management of procedural pain in infants include an effective partnership between healthcare providers and breastfeeding mothers, knowledge mobilization resources in multiple languages, informational support and media campaigns, and experiential learning opportunities for breastfeeding mothers. Conclusions: Successful implementation of baby-friendly hospital initiatives, a patient-centered approach, family-centered care, and the collaborative efforts of healthcare providers in all healthcare settings is recommended to promote the uptake of breastfeeding as analgesia. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effects of white noise on pain-related cortical response, pain score, and behavioral and physiological parameters in neonates with procedural pain. Methods: A double-blind, randomized controlled trial was conducted. Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB (experimental group) or 0 dB (control group) 2 min before radial artery blood sampling and continued until 5 min after needle withdrawal. Pain-related cortical response was measured by regional cerebral oxygen saturation (rScO2) monitored with near-infrared spectroscopy, and facial expressions and physiological parameters were recorded by two video cameras. Two assessors scored the Premature Infant Pain Profile-Revised (PIPP-R) independently when viewing the videos. Primary outcomes were pain score and rScO2 during arterial puncture and 5 min after needle withdrawal. Secondary outcomes were pulse oximetric oxygen saturation (SpO2) and heart rate (HR) during arterial puncture, and duration of painful expressions. The study was registered at the Chinese Clinical Trial Registry (ChiCTR2200055571). Results: Sixty neonates (experimental group, n = 29; control group, n = 31) were included in the final analysis. The maximum PIPP-R score in the experimental and control groups was 12.00 (9.50, 13.00), 12.50 (10.50, 13.75), respectively (median difference −0.5, 95% CI −2.0 to 0.5), and minimum rScO2 was (61.22 ± 3.07)%, (61.32 ± 2.79)%, respectively (mean difference −0.325, 95% CI −1.382 to 0.732), without significant differences. During arterial puncture, the mean rScO2, HR, and SpO2 did not differ between groups. After needle withdrawal, the trends for rScO2, PIPP-R score, and facial expression returning to baseline were different between the two groups without statistical significance. Conclusion: The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score, behavioral and physiological parameters in neonates with procedural pain.

Introduction: Diabetes is a disease with a high incidence in the world population. One of the treatment alternatives for this disease is the use of subcutaneous insulin therapy, daily, most often applied by the patients themselves. As a result, patients that are not properly trained in insulin self-administration may develop complications from its use. Objectives: Describe the evidence in order to explain the difficulties of patients with diabetes in the process of self-administration of insulin. Methods: A literature review was carried out using the scoping review method, in LILACS, CINAHL, PubMed, Cochrane Library, SCOPUS, SciELO, Biblioteca Digital de Teses e Dissertações USP, Busca Integrada USP, and CAPES Thesis Bank. We included articles that had insulin users as participants; that explored the difficulty presented by patients; and that studied the process of insulin self-application. Results: Twenty-six studies published between 1998 and 2020 were selected. The analysis pointed to 12 categories about the difficulties encountered in the self-application process, of which the most relevant were: pain, fear, difficulty in knowing the correct dose and/or adjusting it based on capillary glycemia, lack of knowledge about the application technique, and functional alteration. Conclusion: Pain was the most common objection found in the studies, which reflects its relationship with other difficulties. The difficulty in knowing the dose and/or adjusting it according to capillary blood glucose was presented in a considerable amount, in order to infer the deficiency of health education conducts in Primary Health Care.

GoalTo determine the analgesic effectiveness of repeated sucrose administration for skin-breaking (SB) procedures over the Neonatal Intensive Care Unit (NICU) hospitalization of preterm infants.MethodsLongitudinal observational study, conducted in four level III Canadian NICUs. Eligible infants were

Introduction: Pain management is an integral part of neonatal care. Exposure to pain negatively affects child development with short- and long-term effects, such as persistent and chronic pain, as well as changes in neurobehavioral responses to future painful episodes. The administration of sweet solutions is increasingly used in clinical practice as an established non-pharmacological method. Purpose: To determine the analgesic effect of Sol.Glucose 25% on the reduction of neonatal pain due to heel pricking. Material and methods: Healthy full-term newborns with an average age of 72-84 hours were studied, divided into two groups: non-anesthetised /n= 67/ and anesthetised with Sol. Glucose 25% /n=40/. The child’s reaction to pain is recorded by video surveillance. Its severity was assessed using the scales: the multimodal - Neonatal Infant Pain Scale (NIPS) and the unimodal - Neonatal Facial Coding System (NFCS) 30 sec. before, at the30th-sec. and the 5th min after the painful stimulus caused by the heel prick. Heart rate, transcutaneous saturation, respiratory rate and blood pressure were examined at the same intervals with a Biocare iM/2014 monitor. Physiological markers of pain were monitored in the 12-24 hour interval following heel prick. Descriptive analysis is used to process the results. Results: Before the procedure, the total score according to NIPS and NFCS did not differ significantly between the groups. At the 30th sec. those receiving Sol.Glucose 25% have a higher score than the control group as assessed on both scales.A significant result (p=0.034) was reported only according to NIPS. At the 5th minute, the analgesic effect of Sol.Glucose 25% was confirmed (p=0.016), when applying the multimodal scale - NIPS. When monitoring the physiological indicators, we registered a statistical difference immediately after taking Sol.Glucosae 25% before the procedure - slower breathing (p=0.001), lower transcutaneous oxygen saturation (p=0.012), higher systolic (p=0.005) and diastolic blood pressure (p=0.033). At the 30th sec. a significantly higher heart rate was found in those anesthetised with glucose solution (p=0.023), and on the 5th minute after the procedure, we reported significant differences in two indicators: breathing - slower (p=0.012) and systolic pressure - higher (p=0.020), but they are within physiological norms. In both groups, the oxygen saturation did not reach 95% at the 5th min, but was above 90% and approaching the baseline. Conclusion: Sol.Glucosae 25% has an analgesic effect that allows its application to control procedural pain in fullterm newborns. [ABSTRACT FROM AUTHOR]

Copyright of Minas Gerais Medical Journal / Revista Médica de Minas Gerais is the property of Associacao Medica de Minas Gerais and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: This integrative review aimed to identify, analyse and synthesise studies investigating the clinical efficacy of virtual reality (VR) distraction for children undergoing varying painful and anxiety‐inducing medical procedures across different hospital settings and to identify implications for research and clinical practice. Background: Virtual reality has been leveraged as a distraction tool in the healthcare setting to help patients manage procedural pain and anxiety. Initial studies in the burn wound care setting using VR as a non‐pharmacological analgesia led to the use of VR during other medical procedures. Design: An integrative review of the literature was conducted following the PRISMA guidelines across four electronic databases. Published studies between 2000 and 2020 investigating the clinical efficacy of VR in managing paediatric procedural pain or anxiety were included for review. Results: Reviewed studies collectively included 2,174 patients aged 6 months‐18 years used VR during burn wound care, post‐burn physiotherapy, dental, needle‐related and other procedures. Additionally, ten studies included samples with adults, for which paediatric data could not be isolated (n = 507). Overall, studies supported the efficacy of VR in managing procedural pain and anxiety in the paediatric setting. Conclusion: Virtual reality is redefining pain management by immersing children in a virtual world, reducing pain and anxiety at the hospital. A notable gap was the neglected use of VR in children with chronic conditions receiving orthopaedic procedures as part of their standard care. Relevance to Clinical Practice: Ultimately, VR distraction will reduce the fear associated with medical interventions, preventing increased pain sensitivity, exacerbated anxiety and healthcare avoidance in adulthood. Nurses will play an important role in ensuring the smooth integration of VR in clinical practice by championing the technology and transferring evidence‐based methods for VR use. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to compare the analgesic/sedative effects of various fundus-related procedural pain management strategies on the risk of retinopathy in premature infants. Method: This was a prospective comparative study involving a total of 94 neonates randomized to three groups meeting the criteria for at-risk neonates. Ophthalmologic screening was performed to evaluate the outcome of three procedural pain management strategies. The intensity of pain over time during and after the screening examination was evaluated. At the same time, we also looked at the occurrence of vegetative symptoms and their influence by the chosen medication. Pain response was observed in all 94 neonates enrolled in the study. In group A, no pain treatment was given. Group B had a local anesthetic oxybuprocaine hydrochloride 0.4% introduced into both eyes immediately prior to the examination. Group C received oral clonidine. The study was conducted as a pilot project and aimed to clarify the problem so that a project with a higher proband representation could take place in the future. Consequently, we performed quantitative analysis of complete pain and vegetative functions, followed by a qualitative analysis of their internal components. Results: In our study, we identified the most considerable effects for all three groups, including NIPS (Neonatal Infant Pain Scale) responses immediately during and after the examination. The influence of vegetative functions is of a longer-term nature and increased values can be clearly demonstrated even six hours after the examination. Conclusion: The current results identify and quantify differences among all three methods of pain treatment on the level of single variables. Their internal structures, however, can be analysed only qualitatively because of the small size of the analysed sample. [ABSTRACT FROM AUTHOR]

Abstract Background Burns and related procedures are painful and distressing for children, exposing them to acute and chronic sequelae that can negatively affect their physiological, psychological, and social functions. Non-pharmacological interventions such as distraction techniques are beneficial adjuncts to pharmacological agents for procedural pain, state anxiety, and itch in children with burns but have limitations (e.g. lack of research on burn-related itch, tailoring, and consensus on optimal treatment). Hypnotherapy is a non-pharmacological intervention that can be tailored for varied settings and populations with evidence of benefit for itch and superior effectiveness in comparison to other non-pharmacological interventions for children’s procedural pain and state anxiety. Thus, children with burns can benefit from hypnotherapy as an adjunct to pharmacological agents. Yet, in paediatric burns, rigorous studies of effectiveness are limited and no studies have been identified that screen for hypnotic suggestibility, an important predictor of hypnotherapy outcomes. Considering potential barriers to the delivery of hypnotherapy in paediatric burns, the proposed study will examine the feasibility and acceptability of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety, and itch in children with acute burns. Methods An observational mixed-methods feasibility and acceptability study will be conducted over 15 weeks. Eligible children (N = 30) aged 4 to 16 years presenting to a paediatric burns outpatient centre in a metropolitan children’s hospital in Australia with acute burns requiring dressing changes will be included. Eligible parents of children (N = up to 30) and clinicians who perform dressing changes (N = up to 20) will also be included. Child participants screened as having medium to high suggestibility as assessed by behavioural measures will receive hypnotherapy during dressing changes. A process evaluation will target feasibility and acceptability as primary outcomes and implementation (i.e. fidelity in delivery), reach, potential effectiveness, and adoption of evaluation procedures and intervention as secondary outcomes. Discussion Ethical approval was obtained from the Queensland Children’s Hospital and Health Service ethics committee. Results will be published in peer-reviewed publications and conference proceedings. The findings will guide the design of future trials on the effectiveness of hypnotherapy and inform the development of child-centred hypnotic interventions in children with burns. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620000988954