APS Press Room
News Highlights from The Journal of Pain • February 2007
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
Two New Studies Address Needlestick Pain in Children
Predictors of Topical Anesthetic Effectiveness in Children
Charmaine Kleiber, Debra L. Schutte, Ann Marie McCarthy, Milena Floria-Santos, Jeffrey C. Murray, and Kirsten Hanrahan
University of Iowa College of Nursing
Despite application of topical anesthetic drugs, some children experience significant pain from the insertion of intravenous catheters. Little is known about factors contributing to variable efficacy of topical anesthetics, but studies show that children who are younger and have more difficult temperaments are likely to report pain and exhibit more distress during needlesticks.
In this study, 218 children aged 4 to 10 were evaluated while undergoing catheter insertion. Topical anesthetics were applied in accordance with manufacturers’ specifications, DNA samples were taken, and the children completed the Oucher pain assessment scale. The purpose of the study was to describe the variability of topical anesthetic effectiveness and identify predictors of children’s self-reported pain during an IV insertion following pretreatment with a topical lidocaine anesthetic.
DNA from all subjects was analyzed for three genes believed to influence topical anesthetic effectiveness from their known role in stabilizing membranes that initiate and conduct nerve impulses. The authors reported that children who were more active and had one of the targeted genotypes (EDNRA TT) were more likely to report higher pain intensity from IV insertion despite pretreatment with topical lidocaine. They also found that gender, ethnicity, number of previous painful procedures, and type of topical anesthetic were not associated with pain scores.
Parental Reassurance and Pedictric Procedural Pain: A Linguistic Description
C. Meghan McMurtry, Patrick J. McGrath, Elissa Asp and Christine T. Chambers
Dalhousie University, Halifax, Nova Scotia, Departments of Pediatrics, Psychiatry and Psychology
According the several studies, the amount of pain and distress children experience during needlestick procedures is significantly influenced by parental behavior. Certain behaviors are associated with child coping and others with distress. Humor, commands to use coping strategies, and nonprocedural conversation are associated with increased coping with immunization pain. Empathy, criticisms, apologies, giving control to the child, and reassurance are linked with child distress. In this study, the authors provided a detailed linguistic description of spontaneous reassurances by parents during pediatric immunizations. They examined speech tones, anticipating that parental reassurances would end on a rising voice tone, based on the link between reassuring parental responses and increased child distress. They expected that voice tones ending on a rise would be associated with increased child distress and higher parental anxiety than tones ending in a falling-off pattern.
Videotapes of 28 five-year-old children receiving immunizations with their parents were analyzed. Audio clips were digitized in computer phonetic program that identified voice tone categories.
Contrary to the authors’ expectations, the majority of voice tones used in the reassuring comments from parents ended with a fall in pitch, which communicated certainty and protectiveness instead of uncertainty and vulnerability. They concluded there was no significant relationship between tones ending in a rise and child distress, parental anxiety or parental anticipation of child distress. The authors noted that comprehensive understanding of parental reassurance is valuable because it is the most common response to children in acute pain. Results of this study and others can be used to help parents and healthcare professionals interact with children in a manner that promotes coping and reduces pain and distress during immunizations.
Preamputation Pain and Acute Pain Predict Chronic Pain After Lower Extremity Amputation
Marisol A. Hanley, Mark P. Jensen, Douglas G. Smith, Dawn M. Ehde, W. Thomas Edwards, and Lawrence R. Robinson
University of Washington School of Medicine, Departments of Anesthesiology, Orthopedic Surgery and Rehabilitation Medicine
Pain is normal following surgical limb loss, but some amputees develop chronic pain. Although published research has shown preamputation pain is a risk factor for pain following surgery, little is known about the association between acute post-surgical pain and chronic amputation-related pain. Case studies have reported numerous examples of pain ’memories’ in which painful phantom sensations resemble pain experienced before amputation. Also, several studies have shown that the presence of pre-amputation pain increases the risk of phantom-limb pain (PLP) at 3 or 6 months following amputation, and that preamputation pain also was a risk factor for chronic PLP.
This study was designed to examine the relative roles of pre-amputation pain and acute pain after amputation as predictors of subsequent chronic amputation-related pain. Specific questions addressed were: 1) Does preamputation pain intensity predict subsequent post-operative PLP and/or residual limb pain (RLP) intensity?, and 2) Which types of acute pain are the best predictors of chronic amputation-related pain from 6 to 24 months after surgery? It was hypothesized that higher levels of pain before or soon after amputation might be a variable for selecting those most in need of early, intensive pain interventions.
Fifty-seven lower-limb amputation patients were studied. The average age was 44 and 70 percent of the subjects required amputation from a traumatic injury. Constant pain prior to amputation was reported by 56 percent of study participants.
Results showed that that acute PLP intensity was the single best predictor of chronic pain at six months and one year, while preamputation pain was the best predictor of chronic pain at two years. The authors noted that pain before amputation might produce functional changes or somatic memories in the nervous system that persist after limb loss or are reactivated by the peripheral injury of amputation. The study also suggests that both pre-amputation pain and acute pain soon after amputation might be associated with bothersome chronic pain. This finding might help to identify individuals at greatest for chronic pain problems and most in need of early and intensive pain interventions.