Efficacy of oral mefenamic acid versus paracetamol as a prophylactic analgesic for needle pain in children receiving vaccination: a three-arm, parallel, triple-blind, placebo-controlled MAP VaC randomized controlled trial

BACKGROUND

Needle pain due to routine vaccination is an important factor contributing to low vaccine adherence and immunization coverage. Prophylactic oral analgesics can address this important issue of needle pain related to vaccination. Paracetamol and mefenamic acid are commonly used nonsteroidal anti-inflammatory drugs for pain relief, but there is little published literature on whether the same can be used for needle pain related to vaccination.

OBJECTIVES

This study was planned to compare the efficacy of oral mefenamic acid and paracetamol over placebo as a prophylactic analgesic during vaccination and prophylactic antipyretic during the post-vaccination period.

DESIGNS

Three-arm, triple-blind, randomized controlled trial.

METHODS

This study was conducted at the outpatient department of a tertiary-level medical college in South India from January 2021 to June 2022. In this three-arm interventional trial, each arm had either a single dose of placebo or mefenamic acid (4 mg/kg/dose) or paracetamol (10 mg/kg/dose). These medicines were administered orally 30 min before vaccination to reduce needle pain.

MAIN OUTCOME AND MEASURES

Outcome was measured with the change of FLACC (Face, Leg, Activity, Cry, Consolability) scoring at the time of vaccination, subsequently at 15 and 30 min of vaccination in all three groups. Appearance of fever, grade of fever, and need for antipyretics 24 h after vaccination were also noted.

RESULTS

There was a significant difference in FLACC scores at the time of administration (p = 0.010) and at 15 min (p = 0.014) with mefenamic acid compared to placebo. Although the paracetamol group showed a difference when compared to the placebo, it was not significant at the time of administration (p = 0.401), at 15 min (p = 0.451), or 30 min (p = 0.892) post-vaccination. The appearance of fever, grade of fever, and use of antipyretic up to 24 h post-vaccination had no significant difference among any of the three groups.

CONCLUSION

Mefenamic acid was more potent than placebo for pre-vaccination pain prophylaxis in children. There was no difference in the appearance of fever and its grade among the three groups. The promising results from this trial warrant further large-scale studies to recommend a single oral dose of mefenamic acid to tackle needle pain related to vaccination in children to improve vaccine adherence and coverage.

TRIAL REGISTRATION

CTRI (Clinical trials registry-India) (CTRI/2021/01/030239). [Date of Commencement: 13 Jan 2021, Date of last recruitment: 30 June 2022 (now closed for new participants)].

The effects of sound-and-light toy as a distraction method on pain and physiological parameters in infants regarding circumcision procedure

Background/Aim: Circumcision is a common surgical procedure and a cause of pain and stress for infants. Nurses are in a key role for providing pain relief through implementation of non-pharmacological practices for pain management. This study aimed to assess the impact of distraction using a sound- and light-producing toy on pain and physiological parameters in infants regarding circumcision procedure. Methods: This randomized controlled study was conducted with infants between six months and two years of age who presented to a private circumcision clinic. The sample consisted of 60 infants randomly allocated into intervention (n = 30) and control (n = 30) groups. During the procedure, the mothers of the infants in the intervention distracted the infants with the toy for 15 min. Infants in the control group were accompanied by their mothers during the procedure and did not receive any additional intervention other than the standard care. Data were collected using a questionnaire and the face, legs, activity, cry, consolability (FLACC) pain scale. Data were assessed using descriptive statistical analyses and parametric tests. Results: Infants in the intervention and control groups were similar in terms of current and gestational ages, lengths, weights, and maternal and paternal ages and showed no differences in terms of physiological parameters before and after the procedure (P > 0.05). Post-operative pain scores were lower in infants exposed to the toy with light- and sound than that in the infants in the control group; however, no significant difference between groups was found (P > 0.05). Conclusion: Considering the effect of sound- and light-producing toys on causing a reduction in pain severity, it may be recommended to use distracting practices by nurses to reduce/relieve pain associated with circumcision.

Reducing the Pain of Infants due to Vaccine Injection: A Randomized Controlled Trial

Objective: This study was conducted as a randomized controlled and experimental to compare the effect of breastfeeding and distraction methods on vital signs, pain level, and the duration of crying due to vaccine injection in healthy infants. Methods: The population of the study consisted of 120 infants between 1 and 12 months of age who had met the inclusion criteria. The sample group was randomized and divided into two groups. The control group was breastfeed according to clinical procedure, including 58 infants, and the distraction group was include 62 infants. For both groups, the oxygen saturation (SpO2), heart rate (HR), crying duration, and pain scores were compared both before and following vaccination sessions. Results: The vaccination pain scores of the infants from the distraction group (4.39±2.18) were significantly lower than those of the breastfeeding group (7.05±1.55; p=0.001). The post-vaccination SpO2 was higher in infants in distraction group; whereas, HR was lower in this group compared to the breastfeeding group. The post-vaccination crying durations of those in the distraction group were also shorter than those in the breastfeeding group. Conclusion: The distraction method is adopted by the use of a toy has been found to be effective in decreasing the acute pain during vaccine administrations.

Digital Technology Distraction for Acute Pain in Children: A Meta-analysis

CONTEXT

Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown.

OBJECTIVE

To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures.

DATA SOURCES

Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Institute of Electrical and Electronics Engineers Xplore, Ei Compendex, Web of Science, and gray literature sources.

STUDY SELECTION

Quantitative studies of digital technology distraction for acutely painful conditions or procedures in children.

DATA EXTRACTION

Performed by 1 reviewer with verification. Outcomes were child pain and distress.

RESULTS

There were 106 studies (n = 7820) that reported on digital technology distractors (eg, virtual reality and video games) used during common procedures (eg, venipuncture, dental, and burn treatments). No studies reported on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (standardized mean difference [SMD] -0.48; 95% confidence interval [CI] -0.66 to -0.29; 46 randomized controlled trials [RCTs]; n = 3200), observer-reported pain (SMD -0.68; 95% CI -0.91 to -0.45; 17 RCTs; n = 1199), behavioral pain (SMD -0.57; 95% CI -0.94 to -0.19; 19 RCTs; n = 1173), self-reported distress (SMD -0.49; 95% CI -0.70 to -0.27; 19 RCTs; n = 1818), observer-reported distress (SMD -0.47; 95% CI -0.77 to -0.17; 10 RCTs; n = 826), and behavioral distress (SMD -0.35; 95% CI -0.59 to -0.12; 17 RCTs; n = 1264) compared with usual care.

LIMITATIONS

Few studies directly compared different distractors or provided subgroup data to inform applicability.

CONCLUSIONS

Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over nondigital distractors is not established. Context, preferences, and availability should inform the choice of distractor.

Psychological Interventions for Vaccine Injections in Young Children 0 to 3 Years: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials

Supplemental Digital Content is available in the text.

Background:

This systematic review evaluated the effectiveness of distraction for reducing infant distress during vaccinations in young children aged 0 to 3 years.

Design/Methods:

Database searches identified relevant randomized and quasi-randomized controlled trials. Three separate clinical questions related to variants of the psychological strategy of distraction (directed video; directed toy; nondirected toy) were pursued. Distress was identified as the critical outcome to assess the benefits of distraction and extracted from relevant trials. Distress was analyzed by phase of procedure (distress preprocedure; distress acute; distress recovery; idiosyncratic phases based on some or all of the 3 aforementioned phases).

Results:

Ten studies were included in the review. Significant results are presented herein. For directed video distraction, moderate quality evidence suggested that distress was lowered in the treatment group standardized mean difference (SMD −0.68 lower [95% confidence interval (CI), −1.04 to −0.32]) for the acute+recovery phase as well as the preprocedure phase (SMD −0.49 lower [95% CI, −7.6 to −0.22]). For directed toy distraction, the analysis of low-quality evidence for a combined preprocedure+acute+recovery phase of distress (analysis n=81), suggested that distress was lowered in the treatment group (SMD −0.47 lower [95% CI, −0.91 to −0.02]). An effect for nondirected toy distraction was also seen, analyzing very–low-quality evidence, for the acute distress phase (n=290; SMD −0.93 lower [95% CI, −1.86 to 0.00]).

Conclusion:

Generally low-quality to very–low-quality evidence suggests that there may be an effect of directed (toy and video) and nondirected toy distraction for children aged 0 to 3 years, for certain phases of the vaccination.