A Review of CAM for Procedural Pain in Infancy: Part II. Other Interventions

Near-infrared spectroscopy for objectifying cerebral effects of laser acupuncture in term and preterm neonates

Laser acupuncture (LA) becomes more and more relevant in neonates and infants. With near-infrared spectroscopy (NIRS), a continuous and noninvasive measurement of tissue oxygenation is possible. Aim was to investigate, whether the application of LA was associated with any changes in regional cerebral oxygen saturation (rcSO₂) in term and preterm neonates. The study included 20 neonates (12 males, 8 females). The Large Intestine 4 acupuncture point (LI 4, Hegu) was stimulated by a microlaser needle (10 mW, 685 nm laser needle EG GmbH, Germany) for 5 minutes, bilaterally. All neonates underwent polygraphic recording during undisturbed daytime sleep, including heart rate (HR), peripheral oxygen saturation (SpO₂), and measurement of nasal flow. Using NIRS, rcSO₂ was measured continuously. Cerebral fractional tissue oxygen extraction (cFTOE) was calculated. We did not observe any significant changes in SpO₂ and HR values during the whole observation period. However, there was a significant decrease in rcSO₂ (P = 0.003) within postintervention period, accompanied by a significant increase in cFTOE (P = 0.010) in postintervention period.

A comparative study on vaccination pain in the methods of massage therapy and mothers' breast feeding during injection of infants referring to Navabsafavi Health Care Center in Isfahan

BACKGROUND

Vaccination is one of the most common painful procedures in infants. The irreversible consequences due to pain experiences in infants are enormous. Breast feeding and massage therapy methods are the non-drug methods of pain relief. Therefore, this research aimed to compare the vaccination-related pain in infants who underwent massage therapy or breast feeding during injection.

MATERIALS AND METHODS

This study is a randomized clinical trial. Ninety-six infants were allocated randomly and systematically to three groups (breast feeding, massage, and control groups). The study population comprised all infants, accompanied by their mothers, referring to one of the health centers in Isfahan for vaccination of hepatitis B and DPT at 6 months of age and for MMR at 12 months of age. Data gathering was done using questionnaire and checklist [neonatal infant pain scale (NIPS)]. Data analysis was done using descriptive and inferential statistical methods with SPSS software.

RESULTS

Findings of the study showed that the three groups had no statistically significant difference in terms of demographic characteristics (P > 0/05). The mean pain scores in the breast feeding group, massage therapy, and control group were 3.4, 3.9, and 4.8, respectively (P < 0.05). Then the least significant difference (LSD) post hoc test was performed. Differences between the groups, i.e. massage therapy and breast feeding (P = 0.041), breast feeding group and control (P < 0.001), and massage therapy and control groups (P = 0.002) were statistically significant.

CONCLUSION

Considering the results of the study, it seems that breast feeding during vaccination has more analgesic effect than massage therapy. Therefore, it is suggested as a noninvasive, safe, and accessible method without any side effects for reducing vaccination-related pain.

Procedural pain management for neonates using nonpharmacological strategies: Part 1: sensorial interventions

Neonates who are born preterm and are admitted to neonatal intensive care units endure frequent procedures that may be painful. Nonpharmacological interventions that have been studied to relieve their pain may be categorized in 2 main groups according to their nature: interventions that focus on creating a favorable environment and offering pleasant sensorial stimuli and interventions that are centered on maternal care. These interventions may be considered within the philosophy of developmental care, since they are aimed at adjusting the environment to the needs of the neonate and involve family-centered care. In this article, the first of a 2-part series, we will synthesize the evidence from experimental studies of interventions that focus on the environment and on tactile and gustatory stimulation. The mechanisms suggested by researchers as possible explanations for the efficacy of these interventions are pointed, and the implications for procedural pain management in neonatal care are drawn.

Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: pilot study

BACKGROUND

Heel stick is the most common painful procedure for preterm infants in neonatal intensive care units. Resultant pain causes adverse physiological effects in major organ systems. Kangaroo Care (KC), involving mother-infant skin-to-skin contact is a promising analgesic for infant pain; however, the effect of KC on the autonomic nervous system's response to pain is unknown.

AIM

To determine if KC results in improved balance in autonomic responses to heel stick pain than the standard method where infants remain in an incubator care (IC) for the heel stick.

STUDY DESIGN

A randomized cross-over trial.

SUBJECTS

Fourteen preterm infants, 30-32 weeks gestational age and less than 9 days postnatal age.

OUTCOME MEASURES

Infant behavioral state, heart rate, heart rate variability (HRV) indices including low frequency (LF) and high frequency (HF) power, and the LF/HF ratio measured over Baseline, Heel Warming, Heel Stick, and Recovery periods in KC and IC conditions.

RESULTS

HRV differences between KC and IC were that LF was higher in KC at Baseline (p<.01) and at Heel Stick (p<.001), and HF was higher in KC at Baseline than in the IC condition (p<.05). The LF/HF ratio had less fluctuation across the periods in KC than in IC condition and was significantly lower during Recovery in KC than in IC (p<.001).

CONCLUSIONS

Infants experienced better balance in response in KC than IC condition as shown by more autonomic stability during heel stick. KC may be helpful in mediating physiologic response to painful procedures in preterm infants.

Paediatric Pain Management: Using Complementary and Alternative Medicine

Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Although research is limited for paediatric pain, CAM interventions receiving the most empirical attention include hypnotherapy, acupuncture and music therapy. Evidence also exists for the therapeutic benefits of yoga, massage, humor therapy and the use of certain biological based therapies.