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Factors affecting procedural pain in children during and immediately after intramuscular botulinum toxin injections

M T Fisher1, C K Zigler2, A J Houtrow2

  • 1Division of Pediatric Rehabilitation Medicine, Children's Mercy Hospital, Kansas City, MO, USA.

Journal of Pediatric Rehabilitation Medicine
|September 19, 2018
PubMed

Insights

Younger children experience more pain during botulinum toxin A injections. Topical anesthetics and injection site influence pain, but most patients report mild or no pain post-procedure.

Area of Science:

  • Pediatric Pain Management
  • Neuromuscular Blockade Therapy

Background:

  • Intramuscular botulinum toxin A injections are common in pediatric care.
  • Understanding pain modulation is crucial for improving patient experience.

Purpose of the Study:

  • To identify variables influencing pain during intramuscular botulinum toxin A injections in children.
  • To inform Quality Improvement initiatives for pediatric injection procedures.

Main Methods:

  • Retrospective analysis of 593 procedures involving 249 unique pediatric patients.
  • Comparison of reported pain with patient and procedural variables using subgroup and regression analyses.

Main Results:

  • Mean procedural pain was 3.8 ± 3.0; 83.8% reported no pain and 12.1% mild pain five minutes post-injection.
  • Younger age, use of vapo-coolant spray or topical anesthetic, and body region injected were associated with increased procedural pain.
  • Pain during the procedure and older age increased the likelihood of post-procedure pain; distraction methods did not significantly predict pain ratings.

Conclusions:

  • Procedural pain is significantly influenced by patient age, topical anesthesia, and injected region.
  • The majority of children experience minimal pain within five minutes post-injection.
  • Findings suggest that frequent sedation or anesthesia may not be necessary for these procedures.
Abstract

Keywords:
Botulinum toxinchemoneurolysispainpediatricsspasticity

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