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Published on: November 29, 2017
A randomized-controlled trial of parent-led tactile stimulation to reduce pain during infant immunization injections
Mary-Ellen Hogan1, Janet Probst, Karen Wong
1*Leslie Dan Faculty of Pharmacy, University of Toronto †Women's College Hospital Family Practice Health Centre ‡Department of Psychology, York University §Department of Psychiatry Research, Hospital for Sick Children ∥Toronto General Research Institute ¶Department of Anesthesia and Pain Management, University Health Network #Department of Child Health Evaluative Sciences, Pharmacy, Hospital for Sick Children, Toronto, ON, Canada.
Insights
Parent-led tactile stimulation did not effectively reduce infant pain during immunization shots when combined with standard pain relief methods. Further research into clinician-led tactile stimulation is recommended for better pain management strategies.
Area of Science:
- Pediatrics
- Pain Management
- Immunization Practices
Background:
- Infant pain during immunization injections is a significant concern.
- Evidence-based interventions like sucrose solution and parental holding are used for pain reduction.
- The role of tactile stimulation as an adjunct therapy requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of parent-led tactile stimulation in reducing pain in infants receiving immunizations.
- To assess if parent-led tactile stimulation enhances existing pain-relieving interventions.
Main Methods:
- A randomized controlled trial involving 120 infants aged 4-6 months undergoing routine immunization.
- Infants were assigned to either parent-led tactile stimulation or usual care.
- Pain was assessed using the Modified Behavioral Pain Scale (MBPS) and a visual analogue scale (VAS) by blinded observers and parents.
Main Results:
- No statistically significant difference in MBPS scores between the tactile stimulation group (8.2 ± 1.1) and the control group (8.0 ± 1.3).
- No significant difference in parent-reported VAS scores between the groups (60 ± 20 mm vs. 53 ± 22 mm).
- Infant characteristics were comparable between the two groups.
Conclusions:
- Parent-led tactile stimulation, when added to established pain-relieving interventions, did not reduce pain in infants during immunization injections.
- The study suggests that clinician-led tactile stimulation might be a more effective approach.
- Further research is recommended to explore alternative tactile stimulation methods for infant pain management.
Objective:
To determine the effectiveness of parent-led tactile stimulation for pain reduction when added to a combination of evidence-based pain-reducing interventions in infants undergoing immunization injections.
Methods:
Healthy infants aged 4 to 6 months undergoing routine immunization at a primary care practice were eligible. Infants were randomized to tactile stimulation by a parent or usual care. Parents in the tactile stimulation group rubbed the ipsilateral thigh distal to the site for 15 seconds before, during, and after injections. In addition, all infants received evidence-based pain-relieving interventions including: sucrose solution, holding by a parent, and intramuscular injection without aspiration. The primary outcome was pain, measured by a validated tool, the Modified Behavioral Pain Scale (MBPS), by an observer unaware of treatment allocation using videotapes of the procedure. MBPS scores could range from 0 (no pain) to 10 (maximum pain). Parents, unaware of the study hypothesis, also rated infant pain in real time using a 100 mm visual analogue scale.
Results:
One hundred twenty infants participated. Infant characteristics did not differ (P>0.05) between the tactile stimulation and control groups. Mean MBPS scores and parent visual analogue scale scores did not differ between groups (8.2 [1.1] vs. 8.0 [1.3]; P=0.57) and (60 [20] vs. 53 [22] mm; P=0.10), respectively.
Discussion:
Parent-led tactile stimulation did not reduce pain in infants undergoing immunization injections when combined with other pain-relieving interventions. Potential reasons for the lack of effectiveness are discussed. Investigation of the effectiveness of clinician-led tactile stimulation in this population is recommended.
