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Stress exposure and early-pain procedure might increase the level of EEG and HRV dismaturity, which can ultimately impact the development outcome of the infant., Preterm infants show a higher incidence of cognitive, social, and behavioral problems, even in the absence of major medical complications during their stay in the neonatal intensive care unit (NICU). Several authors suggest that early-life experience of stress and procedural pain could impact cerebral development and maturation resulting in an altered development of cognition, behavior, or motor patterns in later life. However, it remains very difficult to assess this impact of procedural pain on physiological development. This study describes the maturation of electroencephalogram (EEG) signals and heart rate variability in a prospective cohort of 92 preterm infants (

Objective Image-guided breast biopsies are safe, efficient, and reliable. However, patients are often anxious about these procedures, particularly those who have never undergone a prior biopsy. Methods This prospective IRB-approved study surveyed 163 patients undergoing their first breast biopsy. Participants provided informed consent and completed a short written survey prior to and immediately after their procedure. Level of anxiety as well as anticipated and actual levels of pain prior to and following the procedure were assessed using a 0–10-point Likert scale. Correlation, bivariate, and regression analyses were performed. Results Regarding the biopsy experience, 133/163 (81.6%) of patients reported it as better than expected. Anxiety decreased significantly from a prebiopsy mean score of 5.52 to a postbiopsy mean score of 2.25 (P < 0.001). Average and greatest pain experienced during the procedure had mean scores of 2.03 and 2.77, respectively, both significantly lower compared to preprocedural expectation (mean 4.53) (P < 0.001). Lower pain scores were reported in US-guided procedures compared to stereotactic- and MRI-guided biopsies (P < 0.001). No significant differences in pain scores were seen in those undergoing single versus multiple biopsies, or when benign, elevated-risk, or malignant lesions were sampled. Positive correlations were seen with prebiopsy anxiety levels and procedural pain as well as with anticipated pain and actual procedural pain. Conclusion Image-guided biopsies are often better tolerated by patients than anticipated. We stress the benefit of conveying this information to patients prior to biopsy, as decreased anxiety correlates with lower levels of pain experienced during the procedure.

Background Accurate assessments of pain in hospitalized preterm infants present a major challenge in improving the short- and long-term consequences associated with painful experiences. We evaluated the ability of the newborn infant parasympathetic evaluation (NIPE) index to detect acute procedural pain in preterm infants. Methods Different painful and stressful interventions were prospectively observed in preterm infants born at 25 + 0 to 35 + 6 weeks gestation. Pain responses were measured using the composite Premature Infant Pain Profile Revised (PIPP-R) scale, the NIPE index, and skin conductance responses (SCR). Outcome measures were correlations between the NIPE index, the PIPP-R score, and the SCR. Sensitivity/specificity analyses tested the accuracy of the NIPE index and SCR. Results Two hundred and fifty-four procedures were recorded in 90 preterm infants. No significant correlation was found between PIPP-R and the NIPE index. PIPP-R and SCR were positively correlated (r = 0.27, P 10, especially for skin-breaking painful procedures. Conclusions We found no significant correlation between the NIPE index and PIPP-R during routine painful or stressful procedures in preterm infants. Impact Exposure to repetitive pain can lead to neurodevelopmental sequelae. Behavior-based pain scales have limited clinical utility, especially for preterm infants. New devices for monitoring physiological responses to pain have not been validated sufficiently in preterm infants. This study found that the NIPE index was not significantly correlated to the validated PIPP-R scale during acute procedural pain. Secondary analysis of this study showed that NIPE index and SCRs may help to exclude severe pain in preterm infants. In clinical practice, measurements of physiological parameters should be combined with behavior-based scales for multidimensional pain assessments.

Introduction Unnoticed and unrelieved pain is one of the main sources of psychological and physiological stress for intensive care unit (ICU) patients. The eight-item behavior pain assessment tool (BPAT) is a multicountry validated tool to assess pain in ICU patients. However, its feasibility and clinical utility for ICU patients in India need further research. Aims and objectives The Aims and objectives of the study were to assess pain using BPAT and its clinical utility in pain assessment and management in ICU patients. Materials and methods Following ethical approval, 400 consecutive adult patients admitted in the ICUs in a tertiary care teaching hospital were assessed for pain severity using BPAT at intake, baseline pain and procedural pain. Patients 0.85) for each item. The BPAT significantly guided the pain management (p < 0.0001). More than 90% of doctors found BPAT easy to understand and use. In most of the cases (95.5%), doctors agreed that BPAT can improve the clinical management of ICU patients. Conclusion The BPAT is a reliable, brief, and an easy-to-use pain assessment tool, which clinicians can use for guiding pain assessment and management in the ICU setting on a routine basis. Clinical significance We recommend implementing BPAT in the clinical practice for better pain assessment and control in ICU patients. How to cite this article Mitra S, Jain K, Singh J, Saxena P, Nyima T, Selvam SR, et al. Clinical Utility of the Behavioral Pain Assessment Tool in Patients Admitted in the Intensive Care Unit. Indian J Crit Care Med 2020;24(8):695–700.

OBJECTIVE To determine what dose of melatonin is most effective for treating migraine acutely in children and adolescents. BACKGROUND Acute migraine medications may not work for all patients and may cause side effects. Melatonin is effective for migraine prevention in adults and has been used acutely for procedural pain in children. Our goal was to determine whether a "high" or "low" dose of melatonin is more effective for treating migraine acutely in youth. METHODS In this pilot, randomized, open-label, single-center, dose-finding trial, children and adolescents aged 4-17 years with episodic migraine were randomized to "high-dose" or "low-dose" dose melatonin (

To qualify and quantify clinical practices related to pain assessment and non-pharmacologic analgesia (NPA) in newborns in Spanish public maternity hospitals STUDY DESIGN: We surveyed providers online regarding their use of pain assessment scales, NPA interventions in neonates undergoing procedures, as well parents' presence or absence during interventions.The number of painful procedures and the subjective grading of pain from the responding physicians were similar in all hospitals. Only 12.5% of hospitals used pain scales. No NPA was employed in 37.7% of procedures, with less NPA used in the lower complexity hospitals for venous extraction (p 0.001) and gastric lavage (p = 0.001). Respondents reported parents' absence during 56.1% of procedures.Available pain assessment scales and NPA interventions to mitigate pain are being underused. The presence of the parents during painful interventions is low despite the evidence that this may help to reduce newborns' perception of pain.

Background: Intubated and mechanically ventilated patients in the intensive care unit (ICU) may experience pain during routine oral procedures such as oral suctioning and tooth brushing. Despite the importance of pain prevention and management, little is known about patients’ experiences of procedural oral pain. Aims: The aim of this study was to explore patients’ recollections and recommendations for pain and discomfort during routine oral procedures. Methods: A qualitative descriptive design was used. Adult patients were recruited from a mixed medical–surgical–trauma ICU in an academic hospital in Toronto, Canada. Participants were interviewed using object elicitation methods within 7 days of discharge from the ICU. Data were analyzed using directed content analysis methods. Results: We recruited 33 participants who were primarily male (23, 70%), with an average age of 54 (SD = 18) years, admitted with a medical (13, 39%), trauma (11, 33%), or surgical (9, 27%) diagnosis and dentate (27, 82%). Most participants described oral procedures as painful, discomforting, and emotionally distressing. Identified sources of pain included dry, inflamed oral tissues and procedural technique. Procedural pain behaviors were perceived to be frequently misinterpreted by clinicians as agitation, with consequences including physical restraint and unrelieved suffering. Participants advocated for greater frequency of oral care to prevent oral health deterioration, anticipatory procedural guidance, and structured pain assessment to mitigate the dehumanizing experience of unmanaged pain. Conclusions: Patients described routine oral care procedures as painful and recalled suboptimal management of such pain. Procedural oral pain is an important target for practice improvement.

AIM: To investigate the feasibility, and perform a pilot study, of a randomised clinical trial, investigating whether children experience less pain, fear and/or distress when they receive oral ibuprofen vs placebo before a needle is inserted in a subcutaneously implanted intravenous port. METHODS: Twenty-three children were included consecutively and randomised to either oral ibuprofen (n = 12) 7.5 mg/kg body weight or placebo (n = 11). The child's pain, fear and distress were reported by parents, nurses and the children (if ≥7 years of age). Feasibility criteria were defined as (a) ≥4 children included/month, (b) ≥80% of eligible patients agreed to participate, (c) >90% treated according to protocol, (d)

Background Virtual reality (VR) may enhance the effectiveness of psychological interventions for acute pain. We conducted a meta-analysis to assess the efficacy and safety of VR-based interventions for pain associated with medical procedures.Methods We searched PubMed, EMBASE, the Cochrane Library, and PsycINFO until June 17th 2018. We identified randomized controlled trials (RCTs), comparing VR-based psychological interventions to usual care, for pain intensity (primary outcome) or affective and cognitive components of pain (secondary outcomes), assessed real-time or retrospectively. Two independent reviewers performed study selection and data extraction. Risk of bias was independently evaluated by three raters using the revised Cochrane Collaboration tool. A random-effects model using the Paule and Mandel estimator was used for pooling effect sizes.Results 27 RCTs (1452 patients) provided enough data for meta-analysis. Compared to usual care, VR-based interventions reduced pain intensity both real-time (9 RCTs, Hedges' g = 0.95, 95% CI 0.32-1.57) and retrospectively (22 RCTs, g = 0.87, 95% CI 0.54-1.21). Results were similar for cognitive (8 RCTs, g = 0.82, 95% CI 0.39-1.26) and affective pain components (14 RCTs, g = 0.55, 95% CI 0.34-0.77). There was marked heterogeneity, which remained similarly high in sensitivity analyses. Across domains, few trials were rated as low risk of bias and there was evidence of publication bias. Adverse events were rare.Conclusions Though VR-based interventions reduced pain for patients undergoing medical procedures, inferring clinical effectiveness is precluded by the predominance of small trials, with substantial risk of bias, and by incomplete reporting.

Pain is an undesirable tactile and emotional experience related with real or potential tissue harm. Pain prompts people to seek health care more often than any other symptom. It is one of the most important areas of care because people cannot function fully when they are in pain. Pain prompts people to seek health care more often than any other symptom. Painful procedures in the hospital are blood collection, intramuscular injection and intravenous injection etc. this procedural pain is relieved by non pharmacological measures. Procedural pain is the most common cause for pain during provision of nursing care. So as the part of nursing profession, it is our responsibility to use effective strategies to reduce procedural pain. Especially in infant’s routine immunization, bruises and childhood illness mean that pain is a part of everyday experiences of all children and infants. Because infants cannot describe their pain and emotions, it is important to observe the behavioural response of the children to assess the pain. So the present study is done to determine the effectiveness of manual pressure on lumbar region to reduce pain during intramuscular injection among infants in selected hospital, Thiruvalur. Quantitative approach with quasi experimental design was adopted to conduct this study with 60 infants who were selected with purposive sampling technique. The data was collected using structured questionnaire to assess the demographic variable and FLACC pain rating scale for assessing the pain level. The results of the study are out of 60 samples (56.6%) had moderate pain and (43.4%) had mild pain in the experimental group.

The Implementation of Infant Pain Practice (ImPaC) Resource is an eHealth tool designed to support infant pain practice change and ultimately enhance pain outcomes. The aim of this study was to determine users' perspectives on usability, acceptability, and feasibility of the ImPaC Resource. A descriptive prospective mixed-methods quality improvement study was conducted at a pediatric hospital in Canada. Individual "think aloud" interviews were conducted in a nonclinical environment (Phase A); "near live" testing was conducted while users interacted with the Resource in clinical setting (Phase B); individual "think-aloud" interviews were conducted in a nonclinical environment (Phase C). Outcomes included usability (System Usability Scale-SUS), acceptability (Acceptability E-Scale-AES), and feasibility. Interview transcripts were coded per a priori themes using deductive content analysis to create a structured categorization matrix. In Phase A, 10 clinicians interacted with the Resource in individual sessions. Median SUS score was 73.75 (range 52.5-92.5). In Phase B, four clinicians implemented the Resource in the neonatal intensive care unit (NICU) over 4 months. Median SUS score was 85 (82.5-92.5), and median AES score was 24 (21-24). In Phase C, an enhanced prototype was produced, and the same users from Phase B navigated the Resource in individual sessions. Median SUS score was 88.75 (85-95), and median AES score was 27.5 (25-29). Users considered the Resource as feasible for implementation, easy to navigate, engaging, intuitive, comprehensive, and evidence-based. Users highlighted the potential transferability of the Resource to other contexts and settings. The enhanced version of the ImPaC Resource was usable, acceptable, feasible, and met users' expectations and requirements. Results lead the way for evaluation of the Resource in a nationwide cluster randomized trial including 18 NICUs. This knowledge-rich platform is expected to enhance infant pain practices and outcomes in diverse clinical settings.

Background: Children with cancer often undergo long treatment trajectories involving repeated needle procedures that potentially cause pain and distress. As part of a comprehensive effort to develop clinical practice guidelines (CPGs) to address pain prevention and management in children with cancer, we aimed to provide recommendations on the pharmacological and psychological management of procedure-related pain and distress.Methods: Of the international inter-disciplinary CPG development panel (44 individuals), two working groups including 13 healthcare professionals focused on procedural pain and distress. Grading of Recommendations Assessment, Development and Evaluation methodology was used, including the use of systematic literature reviews to inform recommendations and the use of evidence to decision frameworks. At an in-person meeting in February 2018, the guideline panel discussed these frameworks and formulated recommendations which were then discussed with a patient-parent panel consisting of 4 survivors and 5 parents.Results: The systematic reviews led to the inclusion of 48 randomised controlled trials (total number of participants = 2271). Quality of evidence supporting the recommendations ranged from very low to moderate. Strong recommendations were made for the use of topical anesthetics in all needle procedures, for offering deep sedation (DS)/general anesthesia (GA) to all children undergoing lumbar puncture, for the use of DS/GA in major procedures in children of all ages, for the use of hypnosis in all needle procedures and for the use of active distraction in all needle procedures.Conclusion: In this CPG, an evidence-based approach to manage procedure-related pain and distress in children with cancer is presented. As children with cancer often undergo repeated needle procedures during treatment, prevention and alleviation of procedure-related pain and distress is of the utmost importance to increase quality of life in these children and their families. (C) 2020 The Authors. Published by Elsevier Ltd.

Neonates in the neonatal intensive care unit are frequently subjected to painful procedures. Non-pharmacological pain control techniques are useful for reducing procedural pain. Touch as one of the aspects of developmental care used to reduce neonatal pain. The purpose of this study was to determine the effect of gentle human touch during endotracheal suctioning on procedural pain response in preterm neonates.This was a clinical trial study with a crossover design. The study was conducted in a level III NICU in a hospital, affiliated to Iran University of Medical Sciences. Thirty-four neonates were enrolled in this study based on inclusion criteria. The samples were randomly received a sequence of suctioning with/without or suctioning without/with gentle human touch. Preterm Infant Pain Profile (PIPP) was used to collect the data. SPSS version 22 for Windows (SPSS Inc., Chicago, IL, USA) was used for statistical analysis.85.3% of neonates experienced moderate and 8.8% severe pain during suctioning without intervention, and only 64.7% of them experienced moderate and 2.9% severe pain during suctioning with intervention. The results of the pairedResults from this study showed that the pain due to suctioning procedure is considerably reduced by applying Gentle Human Touch. And nurses can use this method as one of the non-pharmacological methods of pain management.

Objective The aim of this study is to evaluate the ability of the Newborn Infant Parasympathetic Evaluation (NIPE) index to detect the response to nociceptive stimuli in nonanesthetized infants and to compare these results to simultaneous scoring by behavioral scales. Study Design Thirty-six nonanesthetized infants admitted to neonatal/pediatric intensive care unit (N/PICUs) were enrolled to the study. Due to faulty records of the data, three patients had to be excluded. To detect pain caused by noxious stimuli, the heart-rate-variability-derived NIPE index and behavioral pain scales designed for measuring procedural pain in nonverbal children were used. Results Forty-one painful events were available for analysis. We observed in the whole group a statistically significant decrease in NIPE values at 1, 2, and 3 minutes after a painful stimulus, in comparison to the NIPE value at rest and the statistically significant differences between the minimum NIPE value within 3 minutes after the stimulus in comparison to NIPE value at rest in the whole group, as well as in the subgroups of moderate and severe pain. Receiver operating characteristic (ROC) analysis has shown the strong sensitivity and specificity of the NIPE in detecting the noxious stimuli (ROC AUC: 0.767). We also found that the stronger the sensation of pain was, the more rapidly NIPE reached its lowest value. Discussion Our study indicates that the painful procedures are associated with a significant decrease in the NIPE value within 3 minutes after a noxious stimulus. Based on our observation, the minimum value within 3 minutes from the painful procedure seems to be the most distinctive value.

Introduction Affordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented reality products. Purpose of the Study The purpose of the present study is to explore the potential of immersive VR to make physical therapy/occupational therapy less painful, more fun, and to help motivate patients to cooperate with their hand therapist. Discussion The following topics are covered: a) psychological influences on pain perception, b) the logic of how VR analgesia works, c) evidence for reduction of acute procedural pain during hand therapy, d) recent major advances in VR technology, and e) future directions—immersive VR embodiment therapy for phantom limb (chronic) pain. Conclusion VR hand therapy has potential for a wide range of patient populations needing hand therapy, including acute pain and potentially chronic pain patients. Being in VR helps reduce the patients’ pain, making it less painful for patients to move their hand/fingers during hand therapy, and gamified VR can help motivate the patient to perform therapeutic hand exercises, and make hand therapy more fun. In addition, VR camera–based hand tracking technology may be used to help therapists monitor how well patients are doing their hand therapy exercises, and to quantify whether adherence to treatment increases long-term functionality. Additional research and development into using VR as a tool for hand therapist is recommended for both acute pain and persistent pain patient populations.

Highlights Abstract Background: Despite evidence to support best practice in neonatal and pediatric venipuncture delivery and procedural support, there are inconsistencies in practice. To inform future research, education, and workforce innovation, the Association for Vascular Access Pediatric Special Interest Group (PediSIG) developed and undertook a survey to describe the current vascular access practice for clinicians caring for neonatal and pediatric patients. Objective: Describe the current state of workforce models, training, and clinical practices surrounding pediatric and neonatal vascular access. Design: Cross-sectional, electronic survey using convenience sampling. Settings: International clinicians who provide vascular access (peripheral intravenous catheter insertion, venipuncture for blood sampling) for neonatal and pediatric patients. Methods: An electronic survey was developed by the PediSIG. The survey covered workforce models, clinician training and competency, pain relief, procedural support, and device securement. The electronic survey was then distributed to the PediSIG membership and shared among several neonatal/pediatric email lists. Data were analyzed descriptively, with an exploration of association between clinical outcomes, workforce, and training. Results: There were 242 responses from 5 countries showing a wide variance of practice. Workforce models showed many different team names and responsibilities along with a variance of personnel and staffing hours. Clinician training was described as 4 hours or less by 44% (n = 69) of respondents. Less than half of the responses (47%; n = 99) reported having a formal procedure to escalate a patient to an expert care and not having a set number of max attempts before escalation. Only two-thirds (n = 115) of respondents said they had a standardized protocol for pain control and procedural support, with only 13% (n = 23) and 15% (n = 27), respectively, self-reporting that they always followed the protocol. Conclusions: The respondents reported a wide variance in neonatal and pediatric vascular access procedures and the resources used to support this practice. Core standards need to be developed to help guide neonatal and pediatric clinicians and their institutions. The standards should encompass recommendations for workforce models, proper training, competency, insertion guidelines, pain control, procedural support, and access to vascular access specialists to provide the best care for every neonate and child.

Objective: procedural pain is unique in that physicians simultaneously cause and assess it. Experienced male physicians are known to underestimate their female patients’ pain more than other physicians. However, it is unknown whether this also occurs in obstetrics/gynecology, where all patients are females. This study addresses the gap in literature on procedural pain assessment accuracy.Methods: the present research compares paired pain evaluations from 20 obstetricians/gynecologists and their 92 female patients. Results: our data demonstrate that patients’ reported pain levels (M=5.53, SD=2.7) were significantly higher than their physicians’ pain estimates (M=4.89, SD=2.19), t=2.64, p < 0.005. The gap between patients’ and physicians’ pain estimates was greatest among physicians with the greatest procedural experience (M=1.49, SD = 2.24), f=5.72, p < 0.005. Male physicians underestimated their patients’ pain significantly more than female physicians do, t=2.27, p < 0.05. Conclusion: our results shed light on systematic underestimation of procedural pain and highlight the significance of experience and sex differences in pain evaluation.Practice Implications: Physicians’ experience influences their perception of patient pain while performing procedures. Experienced male physicians, even those who exclusively treat female patients, need to be aware of this ubiquitous bias in assessing their female patients’ procedural pain

There is increasing evidence that long-term outcomes for infants born prematurely are adversely affected by repeated exposure to noxious procedures. These interventions vary widely, for example, in the extent of damage caused and duration. Neonatal intensive care unit (NICU) procedures are therefore likely to each contribute differently to the overall pain burden of individual neonates, ultimately having a different impact on their development. For researchers to quantify the procedural pain burden experienced by infants on NICU, we aimed to estimate the pain severity of common NICU procedures using published pain scores. We extracted pain scores over the first minute (pain reactivity) from the literature, using 59 randomized controlled trials for 15 different procedures. Hierarchical cluster analysis of average pain scores resulted in 5 discrete severity groups; mild (n = 1), mild to moderate (n = 3), moderate (n = 7), severe (n = 3), and very severe (n = 1). The estimate of the severity of individual procedures provided new insight into infant pain reactivity which is not always directly related to the invasiveness and duration of a procedure; thus, both heel lance and skin tape removal are moderately painful procedures. This estimate of procedural pain severity, based on pain reactivity scores, provides a novel platform for retrospective quantification of an individual neonate's pain burden due to NICU procedures. The addition of measures that reflect the recovery from each procedure, such as brain activity and behavioural regulation, would further improve estimates of the pain burden of neonatal intensive care.

Lumbar puncture (LP) is stressful and often painful. We evaluated the efficacy of a fixed 50% nitrous oxide–oxygen mixture (50%N2O-O2) versus placebo to reduce immediate procedural pain and anxiety during LP performed in an emergency setting. We conducted a randomized controlled trial involving adults who needed a cerebrospinal fluid analysis in an emergency department. Patients were randomly assigned to inhale either 50%N2O-O2 or medical air. The primary endpoint, assessed using a numerical scale, was the maximum pain felt by the patient during the procedure and the maximum anxiety and satisfaction as secondary outcomes. Eighty-eight patients were randomized and analyzed (ITT). The maximal pain was 5.0 ± 2.9 for patients receiving air and 4.2 ± 3.0 for patients receiving 50%N2O-O2 (effect-size = −0.27 [−0.69; 0.14], p = 0.20). LP-induced anxiety was 4.7 ± 2.8 vs. 3.7 ± 3.7 (p = 0.13), and the proportion of patients with significant anxiety (score ≥ 4/10) was 72.7% vs. 50.0% (p = 0.03). Overall satisfaction was higher among patients receiving 50%N2O-O2 (7.4 ± 2.4 vs. 8.9 ± 1.6, p < 0.001). No serious adverse events were attributable to 50%N2O-O2 inhalation. Although inhalation of 50%N2O-O2 failed to reduce LP-induced pain in an emergency setting, it tended to reduce anxiety and significantly increased patient satisfaction.

Kurzfassung Hintergrund: Schmerzhafte medizinische Eingriffe wie Hautpunktionen sind häufige medizinische Eingriffe bei Kindern, die in ein Krankenhaus eingeliefert werden. Diese Eingriffe werden als beängstigende und schmerzhafte Eingriffe empfunden. Deshalb ist der Einsatz wirksamer Methoden zur Schmerzlinderung bei Kindern sehr wichtig. Da der Einsatz von nicht pharmakologischen Mitteln vom gehobenen Dienst für Gesundheits- und Krankenpflege einfach und schnell angewendet werden kann, kosteneffektiv ist und keine Nebenwirkungen aufweist, wird sich diese Arbeit mit Ablenkungskarten und dem Buzzy Gerät beschäftigen.Forschungsfrage: „Wie effektiv sind das Buzzy Gerät und Ablenkungskarten bei einer Hautpunktion von Kindern zwischen 4 – 12 Jahren, in Bezug auf die Schmerzlinderung?“ Methodik: Als methodischer Zugang wurde eine strukturierte Literaturrecherche gewählt. Dabei wurde in den Datenbanken PubMed, Cochrane, Google Scholar und CINAHL nach passenden Publikationen für die vorliegende Arbeit gesucht. Anhand von Suchbegriffen und MeSH Terms, sowie vordefinierten Ein- und Ausschlusskriterien konnte die Literatursuche eingeschränkt werden. Schlussendlich konnten 11 Studien in die strukturierte Literaturrecherche miteingeschlossen werden. Ergebnisse: Von den 11 Studien, welche den Effekt des Buzzy Geräts oder der Ablenkungskarten auf die Schmerzminimierung der Kinder währen einer Hautpunktion untersuchten, zeigten alle eine erfolgreiche Schmerzlinderung in der Interventionsgruppe. 8 Studien zeigten eine signifikante Schmerzminimierung. Schlussfolgerung: Durch das Buzzy Gerät und die Ablenkungskarten erfolgte eine Schmerzminimierung bei Kindern während einer Hautpunktion. Zudem sind beide nicht pharmakologischen Interventionen kosteneffektiv und einfach anwendbar. Abstract Introduction: Painful medical procedures such as skin punctures are common medical interventions for children who are hospitalized. These procedures are perceived as frightening and painful. Therefore, the use of effective methods to relieve pain in children is very important. Because the use of non-pharmacological methods can be easily and quickly applied by the nurse, is cost-effective and has no side effects, this work will deal with distraction cards and the Buzzy device.Research question: “How effective are the Buzzy device and the distraction cards in skin puncture of children aged 4-12 years, in terms of pain relief?” Method: A structured literature search was chosen as the methodological approach. The databases PubMed, Cochrane, Google Scholar and CINAHL were searched for suitable publications for the present bachelor thesis. Using search terms and MeSH terms, as well as predefined inclusion and exclusion criteria, the search strategy was narrowed down. Finally, 11 studies were included in the structured literature search. Results: Out of the 11 studies that examined the effect of the Buzzy device or distraction cards on children’s pain minimization during skin puncture, all showed successful pain relief in the intervention group. 8 studies showed significant pain minimization. Conclusion: The Buzzy device and the distraction cards minimized pain in children during skin puncture. In addition, both non-pharmacological interventions are cost-effective and easy to use. Nicole Maria Oboril Abweichender Titel laut Übersetzung der Verfasserin/des Verfassers Bachelorarbeit FH JOANNEUM 2022

Einleitung: Ein Krankenhausaufenthalt kann für Kinder ein traumatisches Erlebnis darstellen, insbesondere wenn sie invasiven und schmerzhaften Eingriffen unterzogen werden. Invasive Verfahren wie Impfungen, Injektionen oder Blutabnahmen lösen neben Schmerzen auch Angst und Furcht aus und können den weiteren Behandlungsprozess negativ beeinflussen. Die Ablenkung wurde zunehmend eine angesehene Technik in der Pädiatrie. Sie ermöglicht es, Kinder vom akuten schmerzhaften Reiz abzulenken. Methodik: Nach einer systematischen Literaturrecherche konnten mithilfe von Ein- und Ausschlusskriterien in den Online-Datenbanken Cinahl, Pubmed, ScienceDirect und Springer Link passende Studien gefunden werden. Eine Studie wurde mithilfe der Berry-Picking Methode eingeschlossen. Die ausgewählten Studien wurden anhand der Bewertungskriterien von Brandenburg, Panfil und Mayer (2007) beurteilt. Ergebnisse: In zwölf der 13 ausgewählten Studien konnte eine positive Wirkung der Ablenkung auf eingriffsbedingte Schmerzen und Ängste bei Kindern festgestellt werden. Angewendet wurden zum einen aktive Ablenkungstechniken wie der Einsatz von Karten, wobei Kinder unter anderem kleine Rechenaufgaben lösen mussten. Zum anderen wurden auch passive Ablenkungsmethoden, wie der Einsatz von Tablets untersucht. Aus der Analyse der Studien lässt sich schließen, dass jede in dieser Arbeit beschriebene Ablenkungstechnik, Kindern bei der Bewältigung von prozedurbedingten Schmerzen und Ängste unterstützt. Daher sind alle beschriebenen Techniken effektiver als der gänzliche Verzicht auf Ablenkung. Schlussfolgerung: Pflegepersonen sollten aufgrund der signifikanten Ergebnisse und der Zufriedenheit der Kinder und Bezugspersonen, die Anwendung von Ablenkung im Berufsalltag integrieren. Die Ablenkung ist eine sichere und einfach anwendbare nicht-medikamentöse Pflegeintervention. Zukünftige Studien sollten die Altersgruppen weiter einschränken, um adäquatere Ablenkungstechniken in den unterschiedlichen Entwicklungsstufen genauer beleuchten zu können. Introduction: A hospital stay might be a traumatic experience for children, especially when invasive and painful procedures are undergone. Invasive procedures such as vaccinations, injections or blood sampling trigger anxiety and fear in addition to pain and can negatively influence the further treatment process. Distraction has increasingly become a respected technique in pediatrics. It allows children to be distracted from the acute painful stimulus. Methodology: After a systematic literature search, suitable studies were found in the online databases Cinahl, PubMed, ScienceDirect and Springer Link by using inclusion and exclusion criteria. One study was included using the berry picking method. The selected studies were assessed using the evaluation criteria of Brandenburg, Panfil and Mayer (2007). Results: Twelve out of the 13 selected studies found a positive effect of distraction on intervention-related pain and anxiety in children. On the one hand active distraction techniques such as the use of cards, whereby children had to solve small arithmetic problems, were used. On the other hand also passive distraction methods, such as the use of tablets, were investigated. It can be concluded that each distraction technique described in this paper supported children in coping with pain and anxiety related to medical procedures. Therefore, all described techniques are more effective than not using any. Conclusio: Due to the significant results and satisfaction of children and their related ones Caregivers should integrate the use of distraction into their daily work routine. Distraction is a safe and easy-to-use nonmedication nursing intervention. Future studies should further narrow down the age groups to illuminate more adequate distraction techniques at different development stages.

BackgroundPain is a common paediatric problem, and procedural pain, in particular, can be difficult to manage. Complementary therapies are often sought for pain management, including massage therapy (MT). We assessed the evidence for use of MT for acute procedural pain management in children.MethodsWe searched five main databases for (i) primary studies in English, (ii) included children 0 to 18 years of age, (iii) compared MT for procedural pain management to standard care alone or placebo, and (iv) measured pain as the primary or secondary outcome. The data were extracted by one author and verified by a second author. Randomized controlled trials were evaluated using the Cochrane Risk of Bias tool.ResultsEleven paediatric trials of procedural pain in neonatal, burn, and oncology populations, a total of 771 participants, were identified. Eight reported statistically significant reductions in pain after MT compared to standard care. Pain was measured using validated pain scales, or physiologic indicators. The studies were heterogeneous in population, techniques, and outcome measures used. No adverse events associated with MT were identified.ConclusionMT may be an effective nonpharmacologic adjunct for management of procedural pain in children.

Purpose Although many children with cancer cope well with challenges, some experience distress that results in poor adjustment. Children's perceptions of threat may be one explanation for heterogeneity in outcomes, but relatively little is known about what children find threatening. This study aimed to describe the threats that children report. Method Youth (4–18 years old) newly diagnosed with cancer and their primary/parent caregivers (PC) participated in a multi-method study. Appraisals of threat were assessed via self-report and a narrative technique at two weeks post-diagnosis. PCs reported children's anxiety and depressive symptoms three months post-diagnosis and children reported their quality of life (QOL) six months post-diagnosis. Results Youth reported various types of threatening events (e.g., receiving the cancer diagnosis, fear or pain of procedures) across multiple domains (e.g., threat to self, physical threat, threat of loss). Adolescents tended to report threat to life (e.g., the seriousness of the diagnosis itself) whereas younger children reported other threats (e.g., procedural pain). Children with high perceived threat to self had higher subsequent anxiety symptoms and lower QOL compared to those with low appraisals of threat to self. There was also a significant mean difference between high and low appraisals of threat of loss in child reported QOL. Conclusions Youths’ reported threats, as well as how threat appraisals related to adjustment outcomes in distinct ways, underscores the developmental nature of how youth interpret medically stressful events and the utility of developmentally sensitive assessment. Understanding perceived threat could ultimately inform efforts to foster positive long-term adaptation for youth with cancer.

The influence of neonatal experiences upon later-life affective behavior is increasingly recognized, but the reported effects on anxiety are often contradictory. The observed effect may depend upon the type of anxiety (state or trait) affected. The current study aims to investigate whether neonatal repetitive needle pricking alters anxiety behavior in adulthood, by assessing both state and trait anxiety in rats. Sprague–Dawley rat pups received four unilateral needle pricks per day, while controls received four tactile stimuli or were left completely undisturbed during the first postnatal week. Mechanical sensitivity was assessed in the neonatal phase and throughout the development. State anxiety was assessed in the open field test and trait anxiety in the elevated zero maze. The results show that repetitive needle pricking leads to acute mechanical hypersensitivity, but does not affect baseline mechanical sensitivity throughout development. In adulthood, animals previously exposed to neonatal procedural pain (including repetitive handling and removal from litter) showed lower state anxiety but did not differ in trait anxiety, as compared with the undisturbed controls. These findings indicate that early-life procedural pain decreases state but not trait anxiety behavior in later life in a rodent model of repetitive needle pricking.

Goal: To increase oral sucrose use for pain management for common invasive procedures (PIV, lumbar punctures, urine catheterization, venipuncture) in patients 0-6 months of age from 50% to 80% in the YNHH Pediatric Emergency Department within 12 months. Background: Pain is the most common adverse event during minor procedures performed in the pediatric Emergency Department. Inappropriate procedural pain management in young infants can lead to unsuccessful procedures, patient discomfort, and parental dissatisfaction. Many studies have shown that oral sucrose is associated with an …

I.V. catheter placement is one of the most common causes of procedural pain in children. Interventions to address this pain are readily available but inconsistently used in practice. The focus of this article is to identify and encourage best practice for pain mitigation in peripheral I.V. catheter placement in children.

Background:Preterm pain is common in the Neonatal Intensive Care Unit (NICU), with multiple invasive procedures occurring daily.Objective:To review the psychosocial and neurobiological vulnerabilities of preterm infants and to provide an updated overview of non-pharmacological strategies for acute procedural pain in hospitalized preterm infants.Methods:We utilized a narrative review methodology, which also included a synthesis of key pieces of published systematic reviews that are relevant to the current work.Results and Conclusions:Preterm infants are uniquely susceptible to the impact of painful procedures and prolonged separation from caregivers that are often inherent in a NICU stay. Non-pharmacological interventions can be efficacious for mitigating procedural pain for preterm infants. Interventions should continue to be evaluated with high quality randomized controlled trials, and should endeavor to take into account the neurobiological and psychosocial aspects of preterm vulnerability for pain prevention and management strategies.

Background Medical thoracoscopy (MT) under conscious sedation can be a painful procedure. A pilot study reported reduction in procedural pain with lidocaine application via chest tube before procedure. This study aimed at assessing the extent of effect of intrapleural lidocaine on pain during MT in a double-blind randomised trial. Results Thirty patients (mean age 48.3 years) were recruited, 14 randomised to the lidocaine group and 16 to the saline group. In four patients (two from each group), chest tube insertion prior to MT failed, and they were excluded from the final analysis. The mean (SD) visual analogue scale (VAS) pain score during procedure was 49 ± 33.2 for the lidocaine group and 57.4 ± 27.6 for the control group (mean difference − 8.4 points, p = 0.49). The VAS pain score as assessed by operator was 45.6 ± 19.8 for the lidocaine group and 46.6 ± 29.8 for the control group (p = 0.97). There was no difference in the VAS pain score at 120 min post MT or in the doses of sedatives used during procedure between the study groups. Conclusion ICA for MT does not seem to improve procedural pain as suggested by previous studies. Trial registration The study has been registered with the Pan African Clinical Trial Registry (PACTR202008762D159889).

Pain following burn injury is associated with long-term health consequences in the pediatric population. Literature suggests nonpharmacologic treatment may provide improved pain control as an effective adjunct for these patients. This study aims to summarize randomized controlled trials on nonpharmacologic procedural pain management in pediatric burn patients. A systematic review was conducted on nonpharmacologic procedural pain management techniques used in the pediatric burn population. Fifteen studies were included and involved virtual reality, distraction devices, child life therapy, directed play, digital tablet games, cartoons, hypnosis, and music therapy. Treatment was effective in 8 out of 15 studies. Compared to controls, nonpharmacologic treatments reduced mid procedure pain by 19.7% and post-procedure pain by 20.1%. This study demonstrates that nonpharmacologic therapy can be an effective adjunct in pediatric procedural burn pain management, however further studies are needed to develop standardized algorithms to integrate nonpharmacologic treatments with pharmacologic therapies.

BACKGROUND AND OBJECTIVES: Intravitreal injection is a very common surgical procedure in the treatment of diabetic retinopathy, diabetic macular edema, and retinal vein occlusion. Because it’s a treatment that causes pain and discomfort for the patient, therapies that reduce procedural pain are necessary. The aim of the study was to conduct an integrative review on pain management during administration of intravitreal injection. CONTENTS: The study was carried out in January 2021 in three databases (Pubmed, Bireme and Scielo) using the descriptors “intravitreal injections”, “pain management” and “analgesia”. After reading and analysis, 15 articles were selected. The results show several factors associated with pain management during intravitreal injection, such as the use of different anesthetics, needle gauge, injected medication, different surgical instruments and use of music. CONCLUSION: Studies have shown that proparacaine, especially when associated with subconjunctival lidocaine, ranibizumab and alternative techniques for intravitreal injection are preferable approaches to pain management during the procedure. RESUMO JUSTIFICATIVA E OBJETIVOS: A injeção intravítrea é um procedimento cirúrgico muito comum no tratamento de doenças como a retinopatia diabética, o edema macular diabético e a oclusão da veia da retina. Por ser um tratamento que gera dor e desconforto ao paciente, terapias que diminuam a dor procedimental são necessárias. O objetivo deste estudo foi realizar uma revisão integrativa sobre o manejo da dor durante a administração de injeção intravítrea. CONTEÚDO: Estudo realizado no mês de janeiro de 2021 em três bases de dados (Pubmed, Bireme e Scielo) com o uso dos descritores “injeções intravítreas”, “manejo da dor” e “analgesia”. Após a leitura e análise, 15 artigos foram selecionados. Os resultados evidenciaram diversos fatores associados ao manejo da dor durante a injeção intravítrea, como o uso de diferentes anestésicos, calibre da agulha, fármaco administrado, diferentes instrumentos cirúrgicos e uso da música. CONCLUSÃO: Os estudos demonstraram que a proparacaína, principalmente quando associada à lidocaína subconjuntival, o ranibizumabe e as técnicas alternativas de aplicação da injeção intravítrea são abordagens preferíveis no manejo da dor durante o procedimento.

Pain recognition and management continues to be a challenge for health professionals in Neonatal Intensive Care Units. Many of the patients are routinely exposed to repeated painful experiences with demonstrated short- and long-term consequences. Preterm babies are a vulnerable high-risk population. Despite international recommendations, pain remains poorly assessed and managed in many Neonatal Intensive Care Units. Due to there being no general protocol, there is significant variability as regards the guidelines for the approach and treatment of pain between the different Neonatal Intensive Care Units.The objective of this article is to review and assess the general principles of pain in the initial stages of development, its recognition through the use of standardised scales. It also includes its prevention and management with the combination of pharmacological and non-pharmacological measures, as well as to establish recommendations that help alleviate pain in daily clinical practice by optimising pain and stress control in the Neonatal Intensive Care Units. (C) 2021 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U.

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.