What if needle pokes didn't hurt? Hospital implements strategies to eliminate or reduce needle pain in kids

September 13, 2018, Wolters Kluwer Health

A major US children's hospital introduced a first-of-its-kind project to eliminate or reduce pain from elective needle procedures in all infants and children, reports a study in PAIN Reports, part of a special issue on research innovations in pediatric pain. The official open-access journal of the International Association for the Study of Pain (IASP), PAIN Reports.

"This is the first report of a successful system-wide protocol implementation to reduce or eliminate , including pain from vaccinations, in a children's hospital world-wide," write Stefan J. Friedrichsdorf, MD, FAAP, Donna Eull, RN, and their colleagues of Children's Hospitals and Clinics of Minnesota, Minneapolis.

Four Proven Strategies to Reduce Needle Pain in Children

"Pain remains common, under-recognized, and under-treated in children's hospitals and pediatric clinics," the researchers write. At their hospital, over 200,000 patients experienced unrelieved needle pain annually due to vaccinations, blood tests, injections, and other procedures. While patient surveys found that needle procedures were "the single greatest source of pain and anxiety for our patients and families," staff surveys surprisingly gave a low priority to reducing needle pain.

In response, pain medicine specialists and hospital leadership designed and implemented a quality improvement project to eliminate or reduce needle pain. Developed using the "Lean" improvement methodology, the "Children's Comfort Promise" project vowed "to do everything possible to prevent and treat pain." Frontline staff were trained to always, without exception, offer four research-proven strategies:

  • Numbing the skin with topical anesthetic (4% lidocaine cream, available over-the-counter)
  • Giving sucrose (sugar water) or allowing breastfeeding in infants younger than 12 months
  • Using age-appropriate methods of "comfort positioning" (for example, sitting upright on the parent's lap for preschoolers, swaddling for infants), and never holding down or restraining children
  • Age-appropriate distraction (toys, books, games, smartphones, virtual reality)

Between 2014 and 2016, the project was implemented in staggered fashion across the hospital and clinics. As use of the four strategies increased, patient satisfaction with pain management significantly improved. In surveys, families who felt their child's pain was "always well-controlled" rose from 60 to 72 percent. As the project was rolled out, staff concerns about implementation were allayed. Follow-up suggested that pain reduction strategies in infants actually saved time, compared to time spent comforting infants after painful needle procedures, and reduced staff turnover.

"The Children's Comfort Promise has become our institution's new standard of care for needle procedures," Dr. Friedrichsdorf and coauthors write. They note that progress is still needed in some areas—for example, increasing the appropriate use of lidocaine. The strategies are now being introduced and refined at four other North American children's hospitals (Montreal, Toronto, Kansas City and Atlanta), thanks to a grant by the MAYDAY Fund.

The study represents a "real-world" application of research to improve pediatric pain care, according to an introductory editorial by Guest Editor Christine T. Chambers, Ph.D., RPsych. The special issue presents nine original papers highlighting innovations in pediatric pain research and care. Topics include factors associated with the development of pain in children; new research methods in pediatric pain, including culturally sensitive approaches; new theories that point the way toward future advances in controlling pain in children; and abstracts from a recent state-of-the-art conference on pediatric pain management.

Pediatric pain care has made "tremendous progress" since the 1970s and 1980s, when it was widely believed that babies couldn't feel pain and shouldn't receive anesthetics. However, Dr. Chambers writes, "Inadequate continues to be reported for children experiencing painful procedures, after surgery, and in the context of ."

Groups such as the IASP's Special Interest Group on Pain in Childhood actively promote education, research, and advocacy about pain in children. Dr. Chambers concludes, "We all must work hard to push ourselves...to address the problem of poorly managed pediatric pain and ensure that all children and their families receive the pain care they deserve."

Explore further: Psych screening beneficial in pediatric abdominal pain

More information: Stefan J. Friedrichsdorf et al. A hospital-wide initiative to eliminate or reduce needle pain in children using lean methodology, PAIN Reports (2018). DOI: 10.1097/PR9.0000000000000671

Related Stories

Psych screening beneficial in pediatric abdominal pain

August 19, 2018
(HealthDay)—Systematic screening for anxiety, disability, and pain can increase psychological referral rates among pediatric patients with abdominal pain, according to a study published in the August issue of Pediatrics.

Persistent pain common 1 month after elective pediatric surgery

February 1, 2018
(HealthDay)—Many pediatric patients have persistent pain after common ambulatory surgeries, according to a study published online Jan. 20 in Pediatric Anesthesia.

Systematic pain management needed for children in ER

October 29, 2012
(HealthDay)—Steps to manage pain and stress in pediatric emergency medical care are recommended, according to a clinical report from the American Academy of Pediatrics (AAP) published online Oct. 29 in Pediatrics.

Can virtual reality be used to manage pain at a pediatric hospital?

November 7, 2017
Virtual reality has emerged into popular culture with an ever-widening array of applications including clinical use in a pediatric healthcare center. Children undergo necessary yet painful and distressing medical procedures ...

Study IDs pain descriptors for varying stages of low back pain

May 4, 2018
(HealthDay)—Varying pain descriptors may be useful when evaluating patients with different stages of low back pain (LBP), according to a study published online April 30 in PAIN Practice.

Recommended for you

Scientists make significant discovery in the fight against drug-resistant tuberculosis

September 20, 2018
A team of scientists have identified a naturally occurring antibiotic that may help in the fight against drug-resistant Tuberculosis.

Affordable Care Act: Study finds surprising gaps in HIV care providers' knowledge

September 20, 2018
A new study has revealed surprising gaps in some HIV medical providers' knowledge of the Affordable Care Act, with more than a quarter of providers surveyed unable to say whether their state had expanded Medicaid.

Anti-cancer drugs may hold key to overcoming antimalarial drug resistance

September 20, 2018
Scientists have found a way to boost the efficacy of the world's most powerful antimalarial drug with the help of chemotherapy medicines, according to new research published in the journal Nature Communications.

Preventing a dengue outbreak at the 2020 Summer Olympics

September 20, 2018
In 2014, a dengue outbreak unexpectedly occurred in Tokyo. What does that mean for the 2020 summer Olympics and Paralympics being held in the city? Researchers report this week in PLOS Neglected Tropical Diseases that new ...

Researchers discover influenza virus doesn't replicate equally in all cells

September 19, 2018
The seasonal flu is caused by different subtypes of Influenza A virus and typically leads to the death of half a million people each year. In order to better understand this virus and how it spreads, University of Minnesota ...

Flu season forecasts could be more accurate with access to health care companies' data

September 19, 2018
In an era when for-profit companies collect a wealth of data about us, new research from The University of Texas at Austin shows that data collected by health care companies could—if made available to researchers and public ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.