A Comparison of Two Different Tactile Stimulus Methods on Reducing Pain of Children During Intramuscular Injection: A Randomized Controlled Study

IntroductionPediatric patients in the emergency department often require intramuscular injection procedures, which may lead to pain, fear, and anxiety. The purpose of this study was to test a novel nonpharmacological intervention to reduce needle-related pain in the pediatric emergency department.MethodsThe study was conducted as a parallel-group, randomized controlled design. The study population consisted of 159 children aged 7 to 10 years cared for in the emergency department who received an intramuscular injection of ampicillin/sulbactam. The children were randomly assigned to Palm Stimulator, ShotBlocker, or control groups. The children’s preprocedure fear levels were evaluated using the Children’s Fear Scale, and their perceived pain levels during the procedure were evaluated using the Faces Pain Scale-Revised and Visual Analog Scale. Parents and observers also completed the pain level scores.ResultsAccording to all raters (child, parent, and observer), the Palm Stimulator group had the lowest mean Faces Pain Scale-Revised score averages (P < .001). The Visual Analog Scale score averages of the children in the Palm Stimulator group (Visual Analog Scale: M = 27.94, standard deviation = 19.13) were statistically significantly lower than the ShotBlocker (Visual Analog Scale: M = 46.07, standard deviation = 24.96) and control group (Visual Analog Scale: M = 53.43, standard deviation = 29.01) score averages (F = 14.94, η² = 0.16, P = .001).DiscussionThe results of this study support the effectiveness of the Palm Stimulator to reduce perceived pain in children during intramuscular injection administration in the pediatric emergency department.     

Reducing Pain During Emergency Arterial Sampling Using Three Anesthetic Methods: A Randomized Controlled Clinical Trial

BackgroundTaking a sample of arterial blood is widely reported as a cause of significant pain.ObjectivesTo compare three anesthetic methods with standard practice (no anesthesia) to establish which was the most effective in reducing pain caused by radial artery puncture in patients requiring an arterial blood gas test in the emergency department (ED).MethodsA randomized controlled trial was conducted to compare the effectiveness between anesthetic cream, cryoanalgesia, and subcutaneous mepivacaine in reducing pain caused by radial artery puncture in ED patients.ResultsAfter comparing perceived pain during arterial puncture, the lowest median score was obtained in the mepivacaine group (1 interquartile range 0.6–1.3) and the highest median score in the control group (5 interquartile range 4.0–7.0). When comparing the control group with the three intervention groups, the Kruskal-Wallis test showed that mepivacaine (p = 0.023) and cryoanalgesia (p = 0.012) were associated with significantly lower pain scores. The anesthetic cream (p = 0.861) intervention group did not produce a statistically significant median difference compared with the control group.ConclusionsThe results of this study encourage the use of anesthetic methods like cryoanalgesia or mepivacaine for their proven effectiveness in reducing or eliminating pain during arterial puncture.     

The Effect of Virtual Reality and Kaleidoscope on Pain and Anxiety Levels During Venipuncture in Children

PurposeThe study aimed to determine the effect of two different distractions on pain perceptions and anxiety during venipuncture in children.DesignA randomized controlled study.MethodsA total of 139 children aged between 4 and 10 years were included in the study: 46 of them in virtual reality goggle group and 43 in the control group. An information form, the Children’s Anxiety Scale, Visual Analogue Scale, and Wong-Baker Faces Pain Scale were used in the collection of data.FindingsPain and anxiety scores were significantly lower in the virtual reality goggle and kaleidoscope group than in the control group (P < .000).ConclusionsThe use of virtual reality goggle and kaleidoscope methods during venipuncture are effective in reducing children’s perception of pain and anxiety. The most effective method of reducing perception of pain and anxiety is using the virtual reality goggle.     

The Effect of Maternal Voice on Venipuncture Induced Pain in Neonates: A Randomized Study

BackgroundVenipuncture is a common procedure in the neonatal intensive care unit (NICU) and causes significant pain for neonates.AimTo evaluate the effect of maternal voice on pain caused by venipuncture (including peripheral venipuncture and femoral venipuncture) in neonates hospitalized in the NICU.DesignExperimental, randomized controlled study.SettingThe study was conducted in the NICU of two hospitals in China from November 2017 to January 2019.MethodsOne hundred and sixteen neonates were randomly assigned to the maternal voice or routine care groups. The maternal voice group received recorded maternal voice intervention before, during, and after venipuncture. Three phases of procedures were videotaped. Neonatal Infant Acute Pain Assessment Scale (NIAPAS) was assessed by the same evaluator at different phases.ResultsThe study showed that NIAPAS scores, behavioral indicator scores, and physiological indicator scores in the maternal voice group were significantly lower compared with those in the routine care group.ConclusionRecorded maternal voice can improve pain caused by venipuncture in neonates. These are simple, rapid, and cost-effective methods that nurses can implement during venipuncture in neonates.     

Efficacy of Topical Vibratory Stimulation for Reducing Pain During Trigger Point Injection to the Gastrocnemius: A Randomized Controlled Trial

ObjectiveTo evaluate the efficacy of topical vibratory stimulation for reducing pain during trigger point injection (TPI).DesignDouble-blind randomized placebo-controlled clinical trial.SettingTertiary care university hospital.ParticipantsA total of 136 participants were randomly recruited from among patients with myofascial pain syndrome who were scheduled for TPI. Of these, 65 were excluded because they met the exclusion criteria, and 11 because they refused to participate. Finally, 60 participants were enrolled. No participants dropped out of the study.InterventionParticipants were randomly assigned to the vibration group or control group. TPI was performed with 0.5% lidocaine using a 25-gauge needle. A vibrator was applied to the popliteal fossa for 3 to 5 seconds prior to and during TPI to the gastrocnemius; 100-Hz vibration was turned on for the vibration group and turned off for the control group.Main Outcome MeasuresPain intensity during TPI was assessed using a 100-mm visual analog scale (VAS) as a primary outcome, and participant satisfaction and preference for repeated use were measured using 5-point Likert scales as a secondary outcome. These parameters were evaluated immediately after TPI. The primary outcome was evaluated using analysis of covariance and secondary outcome using the Mann-Whitney U test.ResultsVAS scores for pain during TPI were significantly lower in the vibration group (30.30; 95% confidence interval [CI], 22.65-39.26) compared with the control group (47.58; 95% CI, 38.80-56.52; F=7.74; P< .01). The mean difference in VAS scores between the 2 groups was 17.27 (95% CI, 5.24-29.30). Participant satisfaction and preference for repeated use were significantly higher in the vibration group than in the control group (P<.05). No participant showed any side effects.ConclusionTopical vibratory stimulation significantly decreased pain during TPI of the gastrocnemius.     

Effect of Hand Massage on Pain,Anxiety, and Vital Signs in Patients Before Venipuncture Procedure: A Randomized Controlled Trial

BackgroundMassage is one of the relaxation techniques commonly used in recent years to control pain, stress, and anxiety.AimsThis study was conducted to evaluate the effect of hand massage application on pain, anxiety, and vital signs before venipuncture procedure.MethodsThe sample of the study consisted of 97 individuals (48 experimental and 49 controls) who were admitted to a training and research hospital in Turkey between December 2018 and May 2019. Individuals assigned to the experimental group received hand massage. The data were obtained with an individual information form, a visual analog scale (VAS), and the State-Trait Anxiety Inventory (STAI).ResultsThe mean age of the participants was 49.52 ± 12.48 years. There was no significant difference between the pain levels of the experimental and control groups (p > .05), but the anxiety level of the experimental group was significantly less than that of the control group (p < .05). There was also a significant difference between the experimental and control groups in terms of systolic and diastolic blood pressure and heart rate. The blood pressure and heart rate of the experimental group decreased significantly (p < .05).ConclusionHand massage was found to be a simple, non-pharmacologic, inexpensive, and independent nursing practice that could be used to reduce anxiety and positively affect vital signs in patients before venipuncture procedure.     

The Use of Oral Sucrose for Procedural Pain Relief in Infants Up to Six Months of Age: A Randomized Controlled Trial

The aim of this study was to evaluate the effectiveness of oral sucrose in decreasing pain during minor procedures in infants of 1-6 months corrected age. A blinded randomized controlled trial with infants aged 4-26 weeks who underwent venipuncture, heel lance or intravenous cannulation were stratified by corrected age into >4-12 weeks and >12-26 weeks. They received 2 mL of either 25% sucrose or sterile water orally 2 minutes before the painful procedure. Nonnutritional sucking and parental comfort, provided in adherence to hospital guidelines, were recorded. Pain behavior was recorded using a validated 10 point scale at baseline, during and following the procedure. Data collectors were blinded to the intervention. A total of 21 and 20 infants received sucrose and water, respectively, in the >4–12-week age group, and 21 and 22, respectively, in the >12–26-week age group. No statistical differences were found in pain scores between treatment and control groups at any data collection points in either age group. Infants aged >4-12 weeks who did nonnutritional sucking showed statistically significantly lower median pain scores at 1, 2, and 3 minutes after the procedure than those who did not suck. Infants aged >4-26 weeks exhibited pain behavior scores that indicated moderate to large pain during painful procedures; however, there was insufficient evidence to show that 2 mL 25% sucrose had a statistically significant effect in decreasing pain. Infants should be offered nonnutritional sucking in compliance with the Baby Friendly Health Initiative during painful procedures.     

Efficacy of Cartoon Viewing Devices During Phlebotomy in Children: A Randomized Controlled Trial

PurposeThe purpose of this study was to examine the efficacy of different cartoon viewing devices during phlebotomy in children.DesignThis study was a prospective, randomized controlled trial.MethodsThe study included inpatients from the Biochemical Laboratory of a private university hospital in Turkey and was conducted between September 2017 and April 2018. A computer-based random number generator was used to randomly assign the patients into three groups (virtual reality [VR], tablet, and control) with 40 children each. Data were collected using the Wong-Baker FACES Pain Rating Scale and the Children's Fear Scale. Pain and anxiety scores were reported by children, parents, and observers in tablet and control groups. In the VR group, pain and anxiety were determined only by children's reports.FindingsAccording to the children reports, the VR group reported significantly less pain and anxiety than those in the tablet and control groups (P < .05).ConclusionsThe cartoon distraction performed using a VR device reduced the perception of pain and anxiety during phlebotomy in school-age children.     

Laser-assisted Anesthesia Reduces the Pain of Venous Cannulation in Children and Adults: A Randomized Controlled Trial

Objectives: Application of topical anesthetics before intravenous (IV) cannulation is effective yet limited by delayed transdermal absorption. The authors evaluated a handheld laser device to enhance topical anesthetic absorption by ablating the stratum corneum, the major barrier to drug absorption through the skin. The hypothesis was that laser‐assisted anesthesia would reduce the pain of IV cannulation in emergency department (ED) patients. Methods: This was a blinded, randomized, controlled trial. ED patients aged 1 year and older requiring nonemergent IV cannulation were included. Patients were randomized to pretreatment of the skin with laser or sham laser, and standardized venous cannulation was performed on the dorsum of the patients' hands or antecubital fossa. In the experimental group, the area over the target vein was pretreated with a lightweight, portable Er:YAG unit, with a fluence of 3.5 J/cm², a pulse width of 600 microseconds, and a spot diameter of 6 mm. Lidocaine 4% cream was applied to the area immediately after laser application. Five minutes later, the cream was wiped off and a trained nurse inserted an IV catheter. In the control group, a sham laser and lidocaine were used. Pain of laser application and IV cannulation was recorded on age‐appropriate pain scales; presence of infection or abnormal pigmentation was determined at one week. Pain of cannulation was compared using parametric and nonparametric tests. Results: Sixty‐one patients were randomized to laser (30) and sham (31) pretreatment. Mean (± SD) age was 27 (± 21) years, 49% were female, and one half were children younger than 18 years. The mean pain of IV cannulation was significantly less (mean difference, 28.3 mm; 95% confidence interval = 17.9 to 38.7) in patients pretreated with the laser (10.0 mm; 95% confidence interval = 4.4 to 15.6) than with sham laser (38.3 mm; 95% confidence interval = 29.3 to 42.2). The difference in children was also significant. Application of the laser was painless in most patients. No patient developed infection or abnormal pigmentation. Conclusions: Pretreatment of the skin with a laser device followed by a five‐minute topical lidocaine 4% application reduces the pain of IV cannulation in ED adult and pediatric patients.     

氟比洛芬酯和利多卡因联用缓解异丙酚注射痛的随机对照研究

目的 探讨联合应用氟比洛芬酯和利多卡因做静脉预处理缓解异丙酚注射痛的效果.方法 将160例拟行择期手术的ASI 1～2级全麻患者随机分为对照组、利多卡因组(Lc组)、氟比洛芬酯组(FA组)和氟比洛芬酯和利多卡因联用组(联用组),每组各40例.所有患者在给药前均先以橡胶止血带阻断其局部静脉回流,随后分别给予对照组0.9％ NS7 mL,FA组氟比洛芬酯注射液5mL(50 mg)+0.9％ NS 2 mL,Lc组2％利多卡因2mL(40 mg)+0.9％ NS 5 mL,联用组氟比洛芬酯注射液5mL (50 mg) +2％利多卡因2mL (40 mg);2 min后撤止血带,在5s内给入0.5 mg/kg的异丙酚.给药同时由另一位麻醉师以相同的方式及问题询问患者注射部位情况,采用VRS评分.结果 4组间一般情况比较无明显差异.Lc组、FA组、联用组的异丙酚注射痛发生率明显低于对照组(P＜0.05),联用组疼痛发生率低于其余3组.在注射痛强度评分方面,Lc组和联用组的疼痛强度明显低于对照组.术后24 h随访,患者注射部位无红肿、静脉炎或药疹等不良反应情况,亦无预期的胃肠刺激症状.结论 氟比洛芬酯和利多卡因联用做静脉预处理可有效缓解异丙酚注射痛,且不会增加不良反应.     

Use of Virtual Reality for Reducing Pain and Anxiety After Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial

AimThe present study aimed to evaluate the effect of virtual reality on pain and anxiety in patients who had undergone laparoscopic sleeve gastrectomy.MethodThe study was conducted between September 1, 2019, and December 31, 2019, in the surgical intensive care unit at a government hospital. The participants were 110 patients who met the inclusion criteria and agreed to participate in the study. According to the study procedure, while the control group received standard care, the intervention group watched a virtual reality video. Data were collected with a personal information form, the Numeric Pain Rating Scale, and the Faces Anxiety Scale.ResultsThe mean post-test Numeric Pain Rating Scale score was significantly lower in the intervention group than in the control group (p < .001). However, the mean Faces Anxiety Scale scores did not differ significantly between the groups (p = .087).ConclusionsVirtual reality can effectively reduce pain and anxiety in patients who have undergone laparoscopic sleeve gastrectomy in intensive care units.     

Effect of Guided Imagery Meditation During Laparoscopic Cholecystectomy on Reducing Anxiety: A Randomized Controlled Trial

BackgroundUp to 90% of patients still experience pain after abdominal surgery, which also affects their physical recovery and psychological anxiety.AimTo evaluate the effects of guided imagery meditation on ameliorating anxiety, improving the quality of sleep, and relieving postoperative pain in patients after laparoscopic cholecystectomy surgery.MethodIn the general surgical ward of a teaching hospital, patients were randomly assigned to usual care (n = 34) and guided imagery meditation intervention (n = 34) groups, using the method. The measuring outcomes included their anxiety score, quality of sleep, and pain control.ResultsIn terms of the anxiety difference, the experimental group scored 0.42 (standard deviation [SD] = 0.97), while the control group scored 4.79 (SD = 7.56), which indicates a statistically significant difference (F = 8.04, p = .01, partial eta² = 0.11). In terms of quality of sleep, the mean score of the experimental group was 2.67 (SD = 1.96), while the control group scored 7.55 (SD = 3.81), which indicates a significant difference (F = 39.99, p = .001, partial eta² = 0.39). The mean of the degree of postoperative pain was 2.11 points (SD = 1.39), and the score of the control group was 4.00 points (SD = 1.62), which indicates a significant difference (p = .001).ConclusionsGuided imagery meditation is a simple, non-invasive, non-pharmacologic intervention measure. It can reduce anxiety and postoperative pain, and improve the quality of sleep. Thus, it should be promoted in clinical practice.     

The Effect of Position Support During Orthopedic Surgery on Postoperative Pain: A Randomized Controlled Trial

BackgroundPositional pain affect the patient’s healing process after the operation. Anti-pressure positioning pads are medical products used to support the patient positioning during surgical procedures.AimsThe aim of the study was to examine pain related to positioning when anti-pressure gel pads and current visoelastic sponge support options are used during orthopedic surgical cases.DesignThe randomized controlled experimental study.SettingsThe operating room of an educational research hospital.Participants/SubjectsThe study consisted of 100 patients (50 control group and 50 study group) undergoing surgery in a supine position.MethodsInformation form, McGill Melzack Pain Questionnaire, and Visual Analogue Scale were used for data collection. Routine institutional policy was applied to the control group. Study group patients were additionally supported with antipressure position gel pads on the operating table.ResultsThe rate of pain presence in areas other than the operative area was significantly lower in the patients in the study group (p = .001). The patients in the control group reported that preoperative pain in the waist area increased to unbearable levels during operation. In addition, it was noted that the “addition of the anti-pressure gel pads” resulted in study group patients being mobilized significantly early (p = .001).ConclusionsThe conclusion of this study demonstrated that postoperative pain related to positioning, not the surgical procedure itself, was decreased when antipressure gel pads and viscoelastic sponge support were used together. An unanticipated benefit discovered during the study was earlier mobilization of the study group compared to the control group.     

The Relation Between Pain-Related Fear and Disability: A Meta-Analysis

Within a biopsychosocial framework, psychological factors are thought to play an important role in the onset and progression of chronic pain. The cognitive-behavioral fear-avoidance model of chronic pain suggests that pain-related fear contributes to the development and maintenance of pain-related disability. However, investigations of the relation between pain-related fear and disability have demonstrated considerable between-study variation. The main goal of the current meta-analysis was to synthesize findings of studies investigating cross-sectional associations between pain-related fear and disability in order to estimate the magnitude of this relation. We also tested potential moderators, including type of measure used, demographic characteristics, and relevant pain characteristics. Searches in PubMed and PsycINFO yielded a total of 46 independent samples (N = 9,579) that reported correlations between pain-related fear and disability among persons experiencing acute or chronic pain. Effect size estimates were generated using a random-effects model and artifact distribution method. The positive relation between pain-related fear and disability was observed to be moderate to large in magnitude, and stable across demographic and pain characteristics. Although some variability was observed across pain-related fear measures, results were largely consistent with the fear-avoidance model of chronic pain.     

Naltrexone + Bupropion Combination for the Treatment of Binge-eating Disorder with Obesity: A Randomized,Controlled Pilot Study

PurposeBinge-eating disorder (BED), the most prevalent eating disorder, is associated strongly with obesity and functional impairments. Few evidence-based treatments for BED exist; a pharmacotherapy effective in reducing both binge eating and weight needs to be identified. This placebo-controlled double-blind pilot RCT evaluated the acute effects of naltrexone + bupropion (NB) on BED with obesity and examined the longer-term effects through 6-month follow-up after the discontinuation of medication.MethodsTwenty-two adult patients with BED were randomized to receive 12 weeks of double-blind treatment with fixed-dose NB (naltrexone + bupropion XL 50/300 mg) or placebo. Independent (blinded) researcher–clinicians evaluated patients at major outcome time points (baseline, posttreatment, and 6-month follow-up after the treatment period); patients were also evaluated for the tracking of course/tolerability throughout treatments and at 3-month follow-up. Primary outcomes were changes from baseline in binge-eating frequency and percentage weight. Secondary outcomes were changes in eating-disorder psychopathology and depression.FindingsA total of 22 patients were enrolled (86.4% women; mean age, 50.4 years), with 77.3% of patients completing treatments; completion rates (NB, 83.3%; placebo, 70.0%) and adverse events did not differ significantly between NB and placebo. Analyses revealed significant reductions from baseline in binge-eating, eating-disorder psychopathology, depression, and weight during treatment, but these changes with NB did not differ significantly from those with placebo. The percentage of patients who attained 3% weight loss was significantly greater with NB than with placebo (45.5% vs 0%); weight-loss and binge-eating reductions were significantly correlated in the group that received NB. At 6-month follow-up, outcomes remained improved relative to baseline, with no significant differences between NB and placebo.ImplicationsThe findings from this pilot RCT suggest that NB was well-tolerated in these patients with BED and comorbid obesity. Most outcomes were not statistically different between NB and placebo. A larger-scale, adequately powered RCT is needed for determining the efficacy of NB in the treatment of BED. ClinicalTrials.gov identifier: NCT02317744.