Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) for Management of Pain Associated With Hysteroscopy: A Systematic Review.

Transcutaneous electrical nerve stimulation (TENS) therapy is a simple, non-pharmacologic, and non-invasive analgesic intervention that involves the application of electric currents over an area of pain to stimulate underlying nerves. The methodology behind TENS is based on theories of pain perception and processing such as the gate control theory, descending inhibition, and release of endogenous opioids. TENS has also been shown to play a role in the management of pain for gynecologic procedures such as hysteroscopy. Hysteroscopy is an increasingly popular diagnostic and interventional procedure, but its associated pelvic pain is a significant obstacle for patients. This systematic review aims to identify if TENS is an effective analgesic modality during hysteroscopy.

Effect of mechanical vibration and ShotBlocker® on pain levels during heel lance in healthy term neonates: A randomized controlled trial.

PURPOSE: This study aimed to examine the effect of mechanical vibration and the ShotBlocker® device on pain level, crying time, and procedure time during a heel lance in healthy term neonates. DESIGN AND METHODS: A total of 105 healthy-term neonates were randomized into three groups: control (n = 36), mechanical vibration (n = 33), and ShotBlocker® (n = 36). The control group underwent a routine heel lance procedure. The neonates in the mechanical vibration group received mechanical vibration to the extremity for 30 s before the heel was lanced. For the ShotBlocker® group, a ShotBlocker® was placed on the area where the heel lance procedure would occur and the heel was lanced. The heel lance procedure was videotaped, and the neonates' pain scores at 1 min before, 2 min after, and 5 min after the procedure, crying time, and procedure duration were recorded and were evaluated by two independent raters. Data were evaluated using the chi-square test and analysis of variance. The analysis of variance, Bonferroni, Dunnett T3 analysis, and effect size were used in the analyses of repeated measures. The study was approved by an ethics committee. Informed consent was obtained from parents. RESULTS: The pain level of the neonates in the mechanical vibration group was lower than those of the control and ShotBlocker® group during and at 2 min and 5 min after the procedure (F = 12.063, p = 0.000; F = 4.580, p = 0.012; and F = 6.145, p = 0.003, respectively). The duration of neonate crying time in the mechanical vibration group was lower than in the control and ShotBlocker® groups (F = 4.598, p = 0.012). The heel lance duration was similar in the groups (F = 1.369, p = 0.259). CONCLUSION: Mechanical vibration is an effective method to reduce the pain level and crying time associated with heel lance procedures in neonates. PRACTICE IMPLICATIONS: This study provides evidence to nurses that the ShotBlocker is not an effective method for reducing pain associated with the heel lance procedure but that mechanical vibration is an effective method. CLINICAL TRIALS REGISTRATION: The study was registered at Clinical-Trials.gov (NCT06380556).

The use of virtual reality during medical procedures in a pediatric orthopedic setting: A mixed-methods pilot feasibility study.

Medical procedures cause pain and anxiety in children. Distraction techniques, including virtual reality (VR), may be used in healthcare settings to reduce rates of undertreated procedural pain and anxiety. A mixed-methods, concurrent triangulation design was piloted at a pediatric orthopedic hospital to assess the feasibility, clinical utility, tolerability, and initial clinical efficacy of VR distraction during medical procedures received by patients with complex musculoskeletal conditions. Questionnaire, scale, interview, observation, and focus group data were collected from patients, their parents, and healthcare professionals. Triangulation of key quantitative and qualitative findings produced final themes and meta-themes. A total of 44 patients and their parents undergoing intravenous insertions (n = 30), pin removals (n = 7), blood draws (n = 3), Botox injections (n = 2), dressing change (n = 1), and urodynamic test (n = 1) were recruited along with 11 healthcare professionals performing the medical procedures. The following themes resulted from triangulation of data sources: VR intervention was (a) feasible because VR was easily implemented into the clinical workflow, (b) clinically useful as VR was accepted by stakeholders and easy to use, (c) tolerable as VR caused minimal discomfort, and (d) showed initial clinical efficacy in managing procedural pain and anxiety. These findings will inform policies and procedures for VR use in practice and a sustainable implementation across the [name of hospital removed for peer review] network.

Parenting Pain Away: Development and usability testing of an educational website about infant procedural pain management.

All newborns undergo minor painful procedures (e.g., injections). Despite strong evidence supporting parents' efficacy to reduce procedural pain (e.g., breastfeeding), parents remain an underutilized resource. Limited evidence-based resources about infant procedural pain management targeting parents in the perinatal period exist. We co-created Parenting Pain Away, a website to enhance parents' access to information and participation in procedural pain management following birth. This study aimed to conduct iterative usability testing with the perinatal population to refine Parenting Pain Away based on target users' identified needs and satisfaction. In 2020, parents of healthy newborns or expectant parents from an Atlantic Canadian province, participated in two iterative cycles of usability testing of Parenting Pain Away. Through recorded interviews, participants were directed to use the "Think Aloud" approach (e.g., verbalize what they see, think, feel) as they navigated through the website. Participants completed online questionnaires related to demographics and user satisfaction, measured by the Post Study System Usability Questionnaire (PSSUQ). Descriptive statistics and content analysis were conducted to analyze the data. In total, there were 10 participants with an average age of 29.9 years (SD = 3.9). Participants identified as mothers (n = 7) or fathers (n = 3) and were expecting (n = 6) or had a newborn (n = 4). The PSSUQ overall scores were 1.84 (SD = 0.55) and 1.34 (SD = 0.49) in Cycles 1 and 2, respectively, indicating high user satisfaction on the 7-point scale. When comparing between the two cycles, the average overall score was lower in Cycle 2, suggesting improved satisfaction. Participants provided positive feedback about the website and suggested major refinements to simplify content and site navigation. Findings from usability testing cycles were used to inform refinements of the Parenting Pain Away in response to participant satisfaction and feedback. Engaging target users in the development process enhanced this website in preparation for further effectiveness testing.

The effect of three different methods on pain and anxiety in children during blood sampling procedure in pediatric emergency department: Finger puppet, abeslang puzzle, pinwheel.

PURPOSE: The primary objective of this study is to evaluate the effectiveness of finger puppets, abeslang puzzles, and pinwheels in reducing pain and anxiety in children aged 4-6 years during blood sampling procedures in a pediatric emergency department. DESIGN AND METHODS: This study was a four-arm parallel group randomised controlled trial design conducted in the pediatric emergency department of a children's hospital in Western Türkiye between June 2023 and June 2024. Children (n = 160) were randomly assigned into four groups in a 1:1:1:1 ratio. The intervention groups consisted of children aged 4-6 years as finger puppet (n = 40), abeslang puzzle (n = 40), pinwheel (n = 40) and control group (n = 40). Data were collected using Personnel Information Form, Wong-Baker FACES Pain Rating Scale, and the Children's Anxiety Meter-State. The participants themselves, their parents, the nurse and the researcher rated the pain and anxiety levels associated with the blood sampling procedure. These trials are registered with ClinicalTrials.gov (NCT05904483). RESULTS: ANOVA was used to compare the mean Wong-Baker FACES Pain Rating Scale scores among the groups. According to all raters (child, parent, nurse, and researcher), the finger puppet group had the lowest mean score, followed by the pinwheel, abeslang puzzle, and control groups (p < 0.05). According to the nurse and researcher evaluations after the procedure, the finger puppet group had the lowest mean score on The Children's Anxiety Meter-State, followed by the abeslang, pinwheel and control groups (p < 0.05). CONCLUSION: Finger puppet, pinwheel and abeslang puzzle methods were effective in reducing pain and anxiety during blood sampling procedure in children. PRACTICE IMPLICATIONS: Pediatric nurses can safely use finger puppet, pinwheel and abeslang puzzle methods to reduce pain and anxiety during blood sampling procedure in preschool children.

Adjunctive use of hypnosis for clinical pain: a systematic review and meta-analysis.

Systematic reviews suggest that stand-alone hypnotic suggestions may improve pain outcomes compared with no treatment, waitlist, or usual care. However, in clinical practice, hypnosis is often provided adjunctively with other interventions, which might have different effects than those reported in previous reviews. This systematic review aimed to summarize the analgesic effects of adjunctive hypnosis in adults with clinical pain. Seven databases (MEDLINE, Embase, PsycINFO, Emcare, SCOPUS, CENTRAL, Cochrane) were searched up to January 2024. Randomised controlled trials comparing the analgesic effects of adjunctive hypnosis (hypnosis + primary intervention) with those of the primary intervention alone were included. Meta-analyses (random-effects model) calculated mean differences (MD, [95% confidence intervals]) for pain intensity (0-100). Seventy studies were pooled in meta-analyses (n = 6078). Hypnosis adjunctive to usual care had a small additional analgesic effect (chronic pain: -8.2 [-11.8, -1.9]; medical procedures/surgical pain: -6.9 [-10.4, -3.3]; burn wound care: -8.8 [-13.8, -3.9]). Hypnosis adjunctive to education had a medium additional analgesic effect for chronic pain (-11.5 [-19.7, 3.3]) but not postsurgery pain (-2.0 [-7.8, 3.7]). When paired with psychological interventions, hypnosis slightly increased analgesia in chronic pain only at the three-month follow-up (-2 [-3.7, -0.3]). Hypnosis adjunctive to medicines had a medium additional analgesic effect for chronic pain (-13.2, [-22.5, -3.8]). The overall evidence certainty is very low; therefore, there is still uncertainty about the analgesic effects of adjunctive hypnosis. However, hypnosis adjunct to education may reduce pain intensity for chronic pain. Clarification of proposed therapeutic targets of adjunctive hypnosis to evaluate underlying mechanisms is warranted.

NursPainPrevent: A Prospective Observational Study on Pain During a Bed Bath.

BACKGROUND: Although bed baths are known to cause pain, the engendered pain frequency and intensity remain poorly studied. This prospective, observational study was undertaken to examine prospectively, on a given day, patients' bed bath-associated pain in the general in-hospital population. METHODS: Eight external investigators observed 166 bed baths given in 23 units in 5 hospitals. Using validated assessment scales specific to the patients' clinical situations, they established pain scores. RESULTS: Expert observers rated bed bath-induced pain as moderate-to-severe for 48% of the patients, among whom 51.9% had not received prophylactic analgesia prior to the procedure. Only 7.2% benefited from evaluation with a validated pain scale. Astute attention-distraction techniques were applied to shift attention during 16.8% of the bed baths. Caregivers used verbal guidance for 85% of the procedures, and adapted touch and rhythm of the gestures for 84.3%. CONCLUSION: Bed baths generate moderate-to-severe pain intensity. Evaluation and recourse to analgesia remain insufficient despite caregivers' attention accorded to patient comfort and positioning. CLINICAL IMPLICATIONS: The results of this study could contribute to sensitizing professionals to preventing pain linked with routine nursing care. Four axes for improvement were highlighted: evaluation improvement, analgesia, nonpharmacological approaches, and adapted mobilization techniques.

Administration of Nitrous Oxide by Medical Assistants for Painful Procedures in Outpatient Pediatric Settings.

BACKGROUND: Managing pain and distress in children experiencing procedural pain is a priority in pediatric care. Nitrous oxide (pre-mixed formulation of 50% nitrous oxide to 50% oxygen) is widely used to alleviate anxiety or pain during care procedures in various medical domains. This pharmacological intervention is safe to administer to children. Administration by non-anesthesiologist personnel is widespread throughout the world, though it is almost exclusively performed by doctors and nurses. The purpose of this study is to describe the experience of nitrous oxide (N2O) use by medical assistants and safe handling during the performance of painful procedures. METHODS: A retrospective study was conducted in a pediatric outpatient unit of a regional hospital, including medical and surgical consultations. RESULTS: Nitrous oxide was administered by medical assistants to 324 children aged 3 to 19 years. No respiratory and/or cardiovascular problems were noted. Most patients were calm and relaxed. DISCUSSION: The use of N2O for minor procedures in children in a pediatric outpatient unit improved pain management through administration by medical assistants with a high level of satisfaction from patients, parents and health professionals. CONCLUSIONS: This study suggests that the use of nitrous oxide by trained medical assistants can be safe, feasible and effective within the specific context of this study.

Parenting pain away: Quasi-experimental study of an eHealth learning platform to evaluate acceptability, feasibility, and utilisation of parent-led pain management.

AIM: To evaluate the impact of an eHealth educational resource about infant procedural pain management, given during the prenatal period, on feasibility, acceptability, knowledge, self-efficacy, and involvement. BACKGROUND: Routine health care requires newborns to have painful procedures (e.g., intramuscular injection). The impacts of untreated pain in neonates are widely recognised but adoption of effective procedural pain management strategies in clinical practice varies. There is clear evidence supporting the effectiveness of parent-led pain management during procedures (e.g., skin-to-skin care) and reputable resources to raise awareness among parents are warranted. Our team co-created Parenting Pain Away, a website to equip parents with evidence to assist with managing the pain of procedures and empower them to be involved. METHODS: A quasi-experimental evaluation using a pre/post intervention design with low-risk expectant parents. RESULTS: Of the 41 participants, before intervention exposure participants were familiar or had used skin-to-skin care (n = 33), breastfeeding (n = 30) and sucrose (n = 13) as pain management. Most participants (n = 38) desired more information on how to be involved. Providing access to Parenting Pain Away during pregnancy was supported and participants ranked the website above average using the System Usability Scale. Parenting Pain Away did not have a statistically significant influence on outcomes. Participants reported variation in clinical support with parent-led pain management. CONCLUSION: A multifaceted approach is recommended to maintain infant procedural pain management. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Equipping parents with knowledge related to infant pain management using an eHealth approach satisfied their information desires. The study findings are important considerations for perinatal care providers, policy makers, and families to finally achieve adequate procedural pain management. REPORTING METHOD: This study used the STROBE checklist, adhering to EQUATOR guidelines. PATIENT AND PUBLIC CONTRIBUTION: A stakeholder group (expectant parents, parents, perinatal researchers, clinicians, and administrators) was created to inform the study design and intervention.

Neonatal amygdala volumes, procedural pain and the association with social-emotional development in children born very preterm.

Very preterm birth (< 32 weeks' gestational age) is associated with later social and emotional impairments, which may result from enhanced vulnerability of the limbic system during this period of heightened vulnerability. Evidence suggests that early procedural pain may be a key moderator of early brain networks. In a prospective cohort study, neonates born very preterm (< 30 weeks' gestation) underwent MRI scanning at term-equivalent age (TEA) and clinical data were collected (mechanical ventilation, analgesics, sedatives). Procedural pain was operationalized as the number of skin breaking procedures. Amygdala volumes were automatically extracted. The Strengths and Difficulties questionnaire was used to assess social-emotional outcomes at 5 years of age (mean age 67.5 months). General linear models were employed to examine the association between neonatal amygdala volumes and social-emotional outcomes and the timing and amount of procedural pain exposure (early within the first weeks of life to TEA) as a moderator, adjusting for biological sex, gestational age, 5-year assessment age, days of mechanical ventilation and total cerebral volumes. A total of 42 preterm infants participated. Right amygdala volumes at TEA were associated with prosocial behaviour at age 5 (B = -0.010, p = 0.005). Procedural pain was found to moderate the relationship between right amygdala volumes in the neonatal period and conduct problems at 5 years, such that early skin breaking procedures experienced within the first few weeks of life strengthened the association between right amygdala volumes and conduct problems (B = 0.005, p = 0.047). Late skin breaking procedures, experienced near TEA, also strengthened the association between right amygdala volumes and conduct problems (B = 0.004, p = 0.048).

HIGHLIGHTS: ● Preterm birth is associated with social-emotional challenges.● Amygdala volumes at term equivalent age were assessed in relation to preschool social-emotional outcomes.● Larger right amygdala volumes at term-equivalent age were associated with impaired prosocial behaviour at age 5.● Procedural pain moderated the relationship between neonatal amygdala volumes and conduct problems at age 5, with early or late skin breaking procedures strengthening this association.● Dysregulated growth and maturation of the amygdala in preterm neonates were associated with differences in social functioning at 5 years old, with early life procedural pain playing a moderating role.

Distracting children with virtual reality during otomicroscopy: A randomised control trial.

OBJECTIVES: Virtual Reality (VR) is a successful distraction method for reducing procedure-related pain in children, though it has never been studied during otomicroscopy. Therefore, we investigated the efficacy of VR as a distraction method during otomicroscopy. METHODS: This Randomised Control Trial (RCT) included 60 children aged 4-15 years. The patients were randomised to receive distraction by VR, tablet, or no distraction. Procedure-related pain was scored by patients and compared with previous examinations. RESULTS: Patients' experience with otomicroscopy was significantly improved with VR compared to tablet (p < 0.05) and no distraction (p < 0.01). Pain scores did not differ significantly between groups. CONCLUSION: VR did not reduce pain scores, but it improved the children's experience with otomicroscopy without causing significant adverse outcomes.

Using non-pharmacological interventions to manage medical procedure-induced anxiety in children: a framework to guide best practice.

Medical procedure-induced anxiety in children can have short- and long-term negative effects. Research shows that children's anxiety can be affected by non-pharmacological interventions and adults' behaviours in a complex manner. This article presents a scoping review of the literature on non-pharmacological interventions to manage medical procedure-induced anxiety in children. Based on this review, the authors propose a framework comprising six strategies for effective non-pharmacological management of medical procedure-induced anxiety in children. A real-life, and anonymised, example is used to illustrate this framework in practice.

The effects of white noise and swaddling methods on orogastric tube insertion-related pain in preterm infants: A randomized controlled trial.

AIM: This study aims to investigate the effects of the white noise, swaddling and white noise + swaddling methods on pain and physiological parameters associated with orogastric tube insertion procedure. METHODS: This was a randomized controlled trial. A total of 132 preterm infants were randomly assigned to four groups as white noise group (n = 33), swaddling group (n = 33), white noise + swaddling group (n = 33) and control group (n = 33). Interventions were initiated 5 min before the orogastric tube insertion procedure and continued during and up to 5 min after the procedure. RESULTS: White noise intervention alone did not have a significant effect on reducing pain associated with orogastric tube insertion (p > 0.05). Compared with the control group, the preterm infants in the swaddling group experienced 0.587 times less pain, and those in the white noise + swaddling group experienced 0.473 times less pain. CONCLUSIONS: Findings indicate the swaddling and the combination of white noise + swaddling may be a useful intervention in reducing the invasive pain experienced by preterm infants during and after orogastric tube insertion and in improving the physiological parameters associated with pain.

Parent-led neonatal pain management-a narrative review and update of research and practices.

Introduction: Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents' vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills. Methods: In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research. Results: Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain-reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent's and infant's needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals' attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants' procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change. Conclusion: Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.

Undergraduate dental students' perceptions of dental pain in children - A grounded theory study.

INTRODUCTION: There is an underuse of pain management strategies in dental care for children, possibly owing to perceived stress and discomfort when treating children, which has also been reported by dental students. The aim of this study was to explore how undergraduate dental students experience and understand pain related to dental treatment in children. MATERIALS AND METHODS: Interviews were held with 21 Swedish dental students, from 3 dental schools, all in their final 2 years of education. The interviews were transcribed verbatim and analysed according to Grounded Theory. RESULTS: A core category, seeking guidance to avoid pain, was identified and related to 6 conceptual categories. The students used different strategies to manage pain prevention in child dentistry and to become skilled dentists. They described high levels of stress, as well as having high expectations on themselves when treating children. The stress led to a surface learning approach, something the students were not fully aware of. CONCLUSION: All children should have the right to be ensured optimal pain prevention in dental care. The basis for this is laid during undergraduate education. Thus, pain management in child dentistry is an area in need of special attention in this respect. The academic staff has an important role in supporting their students in their process to gain an identity as professional dentists. To ensure that students incorporate an understanding of the importance of pain prevention when treating children there is a need to create more integration between theory and clinical training in undergraduate education.

Effect of combining oral glucose solutions with supportive positions on pain during heel puncture blood sampling in premature infants: A randomized quadruple-blinded experimental study.

PURPOSE: The trial aimed to assess the impact on pain scores of the administration of oral glucose solutions at different concentrations and in combination with supportive positions during heel puncture procedures. DESIGN & METHODS: This trial was structured as a quadruple-blinded experimental study conducted at a single center - a Level II and IVa NICU between June 2022-2023. Included in the study were 128 premature infants born with a gestational age of between 33 and 36 weeks and a postnatal age of <7 days. For the heel puncture procedures, four distinct interventions were employed, each involving supportive positions and oral solutions. All interventions were recorded on video for analysis, and data were collected using the "Infant Information and Observation Form" and "Neonatal Pain, Agitation and Sedation Scale (N-PASS)". The N-PASS was rated by two independent nurses. The data were analyzed with the two-way repeated measures ANOVA and post-hoc Bonferroni tests. RESULTS: The descriptive and clinical characteristics were similar in all groups (p > 0.05). The pain scores, physiological variables and total crying times of the premature infants differed significantly depending on the interventional groups and times, and the interaction between the groups and times (p < 0.05). CONCLUSIONS: Combining glucose solutions with supportive positions led to a reduction in pain scores, a decrease in total crying time when compared to the use of supportive positions alone. PRACTICE IMPLICATIONS: Combining an oral 20% glucose solution with supportive positions can be recommended to reduce pain during unplanned heel puncture procedures in the absence of a parent in the unit.

Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries.

Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the "Children's Comfort Promise", includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the "Global Comfort Promise" was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children's Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child's pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.

The effect of a cognitive behavioural intervention package on peripheral venous cannulation pain, fear and anxiety in Paediatric patients: A randomised controlled trial.

PURPOSE: This study investigated the effect of a cognitive behavioural intervention package (CBIP) on peripheral venous cannulation (PVC) pain, fear and anxiety in paediatric patients aged 7-12 years. DESIGN AND METHODS: This randomised controlled trial included 77 paediatric patients (intervention: n = 39 and control: n = 38). The control group underwent a routine PVC procedure, whereas the intervention group attended the CBIP while undergoing a PVC procedure. Data were collected using a sociodemographic form, the Visual Analogue Scale (VAS), the Wong-Baker FACES (WB-FACES) Pain Rating Scale, the Children's Fear Scale (CFS) and the State-Trait Anxiety Inventory for Children-State Form (STAIC-State). The participants, their caregivers and the researcher scored PVC pain, fear and anxiety levels. The study was approved by an ethics committee. Informed consent was obtained from caregivers, and verbal consent was obtained from children. RESULTS: No significant difference in pre-procedural CFS scores were noted between the CBIP and control groups (p > 0.05). However, the CBIP group had significantly lower mean procedural pain (VAS and WB-FACES), fear (CFS) and anxiety (STAIC-State) scores than the control group (p < 0.05). CONCLUSIONS: The CBIP helped children experience less PVC pain, fear and anxiety. PRACTICE IMPLICATIONS: Nurses can use the CBIP to help reduce PVC pain, fear and anxiety in children. CLINICAL TRIALS REGISTRATION: The study was registered at Clinical-Trials.gov (NCT06018909).

The effect of music on pain management in preterm infants during daily painful procedures: a systematic review and meta-analysis.

Background: The present systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to investigate the effects of music on pain management in preterm neonates during painful procedures. Methods: The PubMed, Embase, Web of Science, EBSCO and Cochrane Library databases were searched to identify relevant articles published from their inception to September 2023. The study search strategy and all other processes were implemented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Four RCTs that satisfied the inclusion criteria were included in this meta-analysis. The music group had significantly lower Premature Infant Pain Profile (PIPP) scores during (RR = -1.21; 95% CI = -2.02--0.40, p = 0.0032) and after painful procedures (RR = -0.65; 95% CI = -1.06--0.23, p = 0.002). The music group showed fewer changes in PIPP scores after invasive operations than did the control group (RR = -2.06; 95% CI -3.16--0.96; p = 0.0002). Moreover, our results showed that music improved oxygen saturation during (RR = 3.04, 95% CI = 1.64-4.44, p < 0.0001) and after painful procedures (RR = 3.50, 95% CI = 2.11-4.90, p < 0.00001). However, the change in peak heart rate during and after painful procedures was not statistically significant (RR = -12.14; 95% CI = -29.70-5.41 p = 0.18; RR = -10.41; 95% CI = -22.72-1.90 p = 0.10). Conclusion: In conclusion, this systematic review demonstrated that music interventions are effective for relieving procedural pain in preterm infants. Our results indicate that music can reduce stress levels and improve blood oxygen saturation. Due to the current limitations, large-scale, prospective RCTs should be performed to validate the present results.

A nitrous oxide/oxygen fixed mixture to reduce pain induced by the hypodermic injection: study protocol for a randomized, controlled trial.

BACKGROUND: Patients with hematological malignancies received multiple hypodermic injections of recombinant human granulocyte colony-stimulating factor. Procedural pain is one of the most common iatrogenic causes of pain in patients with hematological malignancies. It is also identified as the most commonly occurring problem in clinical care in the Department of Hematology and Oncology at Shenzhen University General Hospital. However, providing immediate relief from pain induced by hypodermic injection of recombinant human granulocyte colony-stimulating factor remains a major challenge. This trial aims to evaluate the safety and analgesic efficacy of a fixed nitrous oxide/oxygen mixture for patients with hematological malignancies and experiencing procedural pain caused by hypodermic injection of recombinant human granulocyte colony-stimulating factor in the department. METHODS: The nitrous oxide/oxygen study is a single-center, randomized, double-blind, placebo-controlled trial involving patients with hematological malignancies who require hypodermic injections of recombinant human granulocyte colony-stimulating factor for treatment. This trial was conducted in the Hematology and Oncology Department of Shenzhen University General Hospital. A total of 54 eligible patients were randomly allocated to either the fixed nitrous oxide/oxygen mixture group (n = 36) or the oxygen group (n = 18). Neither the investigators nor the patients known about the randomization list and the nature of the gas mixture in each cylinder. Outcomes were monitored at the baseline (T0), immediately after hypodermic injection of recombinant human granulocyte colony-stimulating factor (T1), and 5 min after hypodermic injection of recombinant human granulocyte colony-stimulating factor (T2) for each group. The primary outcome measure was the score in the numerical rating scale corresponding to the highest level of pain experienced during hypodermic injection of recombinant human granulocyte colony-stimulating factor. Secondary outcomes included the fear of pain, anxiety score, four physiological parameters, adverse effects, total time of gas administration, satisfaction from both patients and nurses, and the acceptance of the patients. DISCUSSION: This study focused on the safety and analgesic efficacy during hypodermic injection of recombinant human granulocyte colony-stimulating factor procedure. Data on the feasibility and safety of nitrous oxide/oxygen therapy was provided if proven beneficial to patients with hematological malignancies during hypodermic injection of recombinant human granulocyte colony-stimulating factor and widely administered to patients with procedural pain in the department. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR2200061507. Registered on June 27, 2022. http://www.chictr.org.cn/edit.aspx?pid=170573&htm=4.