Music Therapy During Basic Daily Care in Critically Ill Children: A Randomized Crossover Clinical Trial.

OBJECTIVE: To assess whether music therapy (MT) is effective to reduce pain during daily personal hygiene care (DPHC), a procedure performed in all patients in a pediatric intensive care unit. METHODS: Fifty critically ill children were enrolled in a crossover controlled clinical trial with random ordering of the intervention, that is, passive MT, and standard conditions, and blind assessment of pain on film recordings. The primary outcome was variation of the Face Legs Activity Cry Consolability (FLACC) score (range, 0-10) comparing before and during DPHC. Secondary outcomes were changes in heart rate, respiratory rate, and mean arterial blood pressure, and administration of analgesic or sedative drugs during DPHC. Mixed-effects linear model analysis was used to assess effect size (95% CI). RESULTS: The median (Q25-Q75) age and weight of the patients were 3.5 years (1.0-7.6 years) and 15.0 kg (10.0-26.8 kg). Consecutive DPHC were assessed on days 3 (2-5) and 4 (3-7) of hospitalization. In standard conditions, FLACC score was 0.0 (0.0-3.0) at baseline and 3.0 (1.0-5.5) during DPHC. With MT, these values were, respectively, 0.0 (0.0-1.0) and 2.0 (0.5-4.0). Rates of FLACC scores of >4 during DPHC, which indicates severe pain, were 42% in standard conditions and 17% with MT (P = .013). Mixed-effects model analysis found smaller increases in FLACC scores (-0.54 [-1.08 to -0.01]; P = .04) and heart rate (-9.00; [-14.53; -3.40]; P = .001) with MT. CONCLUSIONS: MT is effective to improve analgesia in critically ill children exposed to DPHC. TRIAL REGISTRATION: This study was recorded (April 16, 2019) before patient recruitment on the National Library of Medicine registry (NCT03916835; https://clinicaltrials.gov/ct2/show/NCT03916835).

Effectiveness of non-immersive virtual reality in the management of procedure-related pain in preschool children: a randomized clinical trial.

The objective of this study is to assess the effectiveness of non-immersive virtual reality as a pain-distraction measure in children between the ages of 3 and 5 years undergoing painful injection procedures in an outpatient setting. We carried out a randomized, unmasked clinical trial in children undergoing venipuncture or intramuscular injection procedures. Patients were randomized to a distraction virtual reality video or standard care. After the procedure, three independent observers (parents, researchers, nursing staff) rated pain on the LLANTO pain scale. We recruited 122 subjects, half of which were randomized to virtual reality. The median age was of approximately 60 months (IQR: 15 months), and the sample was balanced with regard to sex. There were significant differences in LLANTO scales scores between the VR subjects and controls of - 3.34 (95% CI - 4.15; - 2.54), - 3.02 (95% CI - 3.90; - 2.14), and - 2.98 (95% CI - 3.87; - 2.09), as rated by parents, researchers, and nursing staff, respectively. Agreement between raters was high for all three types of observers, with Cohen Kappas over 0.79 in all cases. Bivariate analysis showed reductions in the risk of obtaining higher scores in the LLANTO scale. Linear regression models showed a reduction of approximately 3 points in the scale, regardless of the type of observer. These models were adjusted for sex, age, kind of procedure, use of prior analgesia, and recruitment center. CONCLUSIONS: Non-immersive virtual reality is an effective adjunctive therapy for the reduction of pain in children undergoing painful injection procedures in an outpatient setting. This strategy may be used to improve the quality of care in pediatric outpatient services. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03985930 (Registered June 14, 2019). WHAT IS KNOWN: •The use of immersive virtual reality (VR) has been described as an effective adjunctive distraction method during painful procedures in children over 5 years. WHAT IS NEW: •The utility of non-immersive VR in children below that age is not yet clear. This randomized clinical trial comparing non-immersive VR vs. standard care showed an average reduction of three points in the LLANTO pain scale favoring non-immersive VR. Non-immersive VR is an effective and inexpensive non-pharmacological technique that reduces fear and pain in pediatric patients.

Analgesia por láser de baja potencia en pacientes con tratamiento ortodóncico / Low power laser analgesia in patients with orthodontic treatment i: en

Introducción: El dolor es el síntoma más común luego de la primera activación de la aparatología ortodóncica. El tratamiento analgésico más utilizado es el paracetamol; sin embargo, su uso inhibe la actividad de la ciclooxigenasa y la síntesis de prostaglandinas, lo que puede afectar el mecanismo del movimiento dental y el remodelado óseo. Objetivo: Evaluar la efectividad del láser de baja potencia para el alivio del dolor en pacientes con tratamiento ortodóntico. Métodos: Se realizó un estudio cuasiexperimental de intervención terapéutica, desde enero hasta diciembre de 2020, en 40 pacientes atendidos en la consulta de ortodoncia del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, en quienes se aplicaría fuerza ortodóncica por primera vez. Estos fueron distribuidos de forma aleatoria en 2 grupos de 20 integrantes cada uno: el de estudio, tratado con láser de baja potencia, y el de control, que recibió medicación convencional (paracetamol). Para la validación estadística de la información se emplearon el porcentaje y la prueba de la t de Student para muestras independientes, con 95 % de confiabilidad. Resultados: Luego de tres sesiones terapéuticas, 90,0 % del grupo de estudio refirió no presentar dolor o sentirlo de forma leve, mientras que del grupo de control solo 10,0 % de los pacientes fue ubicado en cualquiera de las dos categorías anteriores. Existió diferencia significativa entre ambos grupos (p=0,00). Conclusiones: Se demostró que el láser, como terapia alternativa, fue más efectivo que el paracetamol.

Introduction: Pain is the most common symptom after the first activation of orthodontic appliance. The most widely used analgesic treatment is paracetamol; however, its use inhibits cyclooxygenase activity and prostaglandin synthesis, which can affect the mechanism of tooth movement and bone remodeling. Objective: To evaluate the effectiveness of low power laser for pain relief in patients with orthodontic treatment. Methods: A quasi-experimental study of therapeutic intervention was carried out, from January to December 2020, in 40 patients treated at the orthodontic clinic of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, in whom orthodontic force was applied for the first time. These were randomly distributed into 2 groups of 20 members each: the study group, treated with low-power laser, and the control group, that received conventional medication (paracetamol). For statistical validation of data, the percentage and the Student's t test for independent samples were used, with 95 % confidence interval. Results: After three therapeutic sessions, 90.0% of the study group reported not presenting pain or feeling it slightly, while only 10.0% of patients in control group were put in any of the two previous categories. There was a significant difference between both groups (p=0.00). Conclusions: Laser, as an alternative therapy, was shown to be more effective than paracetamol.

Efficacy of hypnosis in the management of non-procedural pain: systematic review / Eficácia da hipnose no manejo da dor não procedimental: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Pain has great impact on public health and presents a social cost which transcends the financial aspect. Hypnosis is a focal, quick and low-cost resource with effective change possibilities in pain management. The objective of this study was to identify evidence of the efficiency of hypnosis in pain management. CONTENTS: This study consists of a systematic literature review held in February 2020. Search was carried out in the Pubmed, Cochrane, LILACS, Scielo and PsycInfo platforms, using the keywords "clinical trials", "hypnosis", "pain management", "pain intensity", and "quality of life", totalizing 18 studies after peer review. Most articles are randomized, controlled by comparing hypnosis to standard treatment or other integrative practices, and focus mainly on the aspects of intensity, quality and interference of pain as an outcome variable. Six studies mention quality of life and only two refer catastrophization as an important intervening variable. CONCLUSION: Hypnosis is an effective technique for pain management, considering that there was an improvement in pain management with the improvement of at least one aspect, be it intensity, interference or quality of pain. However, it's necessary to highlight important limitations of the studies, such as the small sample size and the complexity of systematizing subjective techniques, which highlights the need for more clinical trials, including multicentric studies, so that larger samples can be obtained.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor tem um amplo impacto na saúde pública, apresentando um custo social que extrapola o financeiro. A hipnose mostra-se como recurso focal, breve e de baixo custo, com possibilidades efetivas de mudança no manejo da dor. O objetivo deste estudo foi verificar a eficácia da hipnose no manejo da dor não procedimental. CONTEÚDO: Trata-se de uma revisão sistemática da literatura realizada em fevereiro de 2020. As buscas foram realizadas nas plataformas Pubmed, Cochrane, LILACS, Scielo e PsycInfo, utilizando-se os descritores "ensaio clínico", "hipnose", "manejo de dor", "intensidade de dor" e "qualidade de vida", totalizando 18 estudos após a avaliação de pares. A maioria dos estudos era randomizada, controlada por comparação da hipnose com tratamento padrão ou outra prática integrativa e centrava-se principalmente nos aspectos de intensidade, qualidade e interferência da dor como variável desfecho. Seis estudos fazem menção à qualidade de vida e apenas dois se referem à catastrofização como variável interveniente importante. CONCLUSÃO: A hipnose é uma técnica eficaz no manejo da dor, considerando que houve melhora no manejo da dor a partir da melhora em, pelo menos, um aspecto, seja intensidade, interferência ou qualidade da dor. No entanto, é preciso ressaltar importantes limitações dos estudos, como o tamanho reduzido das amostras e a complexidade de sistematização das técnicas subjetivas, o que evidencia a necessidade de mais ensaios clínicos, inclusive multicêntricos, de modo a garantir amostras maiores.

Management of Procedural Pain in Children.

In recent years, there has been increased interest in the study of pain in children and its treatment. It is known that when facing diagnostic and therapeutic procedures similar to those performed on adults, children either do not receive specific pain treatment or receive it on a significantly lower scale. However, recent research suggests a change in attitude and an improvement in the current treatment of children's pain. Although current knowledge demonstrates the falsity of many preconceived ideas about pain and its management, our results suggest that attitudinal change towards childhood pain remains slow and that real improvement in the training and practical application of the pediatrician who has to treat childhood pain is urgently needed. In this context, this manuscript has prepared standards and guidelines to improve pain management practices in a large number of national and international professional settings.

Características clínicas da doença de Parkinson associadas à dor ao tratamento odontológico / Clinical characteristics of Parkinson's disease associated with dental treatment-related pain

Resumo Introdução A Doença de Parkinson (DP) resulta em condições clínicas desfavoráveis para a saúde bucal e não existe estudo publicado sobre dor ao tratamento odontológico em pacientes com DP. Objetivo Pesquisar associação entre características clínicas da DP e a intensidade de dor em decorrência de tratamentos odontológicos. Material e método Foi utilizada uma amostra consecutiva de 70 pacientes com DP, nos quais foram realizados 217 procedimentos odontológicos invasivos. Tempo de DP foi coletado do prontuário odontológico; estágio da DP foi definido por meio da escala de Hoehn e Yahr; défice cognitivo, por meio do Mini Exame do Estado Mental; depressão, por meio do Inventário de Depressão de Beck; e comprometimento motor, por meio da escala UPDRS/AVD. Os pacientes foram questionados se no último mês sentiram alguma sensação de dormência, formigamento, queimação ou dor bem como dificuldade para sentir cheiros ou gostos. A dor relacionada ao tratamento foi coletada por meio de uma escala numérica de dor com valores de 0 a 10. Resultado O nível de dor percebida pelos pacientes durante o tratamento odontológico não apresentou associação significativa com tempo de DP, estágio da DP, comprometimento motor nem ocorrência de depressão. Maior nível de dor foi estatisticamente mais frequente entre aqueles com défice cognitivo e aqueles que relataram a presença de maior número de sintomas sensitivos, sobretudo dormência e queimação. Conclusão A dor ao tratamento odontológico em pacientes com DP está associada aos sintomas não motores desses pacientes, especificamente o défice cognitivo e a presença de sintomas sensitivos.

Abstract Introduction Parkinson's disease (PD) results in unfavorable clinical conditions for oral health and there is no published study on pain during dental treatment in PD patients. Objective To investigate association between clinical characteristics of PD and the intensity of pain due to dental treatments. Material and method A consecutive sample of 70 patients with PD was used, in which 217 invasive dental procedures were performed. PD duration was collected from dental records; PD stage was defined using the Hoehn and Yahr scale; cognitive deficit, using the Mini Mental State Examination; depression, using the Beck Depression Inventory; and motor impairment, using the UPDRS-AVD scale. Patients were asked whether in the last month they felt any numbness, tingling, burning or pain sensation; as well as difficulty in smelling or tasting. Treatment-related pain was collected using a Numerical Pain Scale with values ranging from 0 to 10. Result the level of pain perceived by patients during dental treatment was not significantly associated with PD duration, PD stage, motor impairment or occurrence of depression. The frequency of patients who reported a higher level of pain was statistically higher among those with cognitive impairment and those who reported the presence of a greater number of sensory symptoms, especially numbness and burning. Conclusion Pain related to dental treatment in PD patients is associated with non-motor symptoms of these patients, specifically the cognitive impairment and the presence of sensory symptoms.

Procedural Pain during Insertion of a Continuous Glucose Monitoring Device in Preterm Infants.

Procedural pain was compared between the insertion of a continuous glucose monitoring sensor and heel stick using the Premature Infant Pain Profile in a single-blinded controlled trial in preterm infants (≤32 weeks of gestation or birth weight ≤1500 g) (ClinicalTrials.govNCT02583776). Continuous glucose monitoring insertion was associated with lower pain scores compared with the heel stick.

Neonatal procedural pain can be assessed by computer software that has good sensitivity and specificity to detect facial movements.

AIM: The difficulty in assessing pain during the neonatal period is one of the main obstacles for appropriate analgesia in intensive care units. The aim of this study was to develop and validate computer software to monitor neonatal facial movements of pain in real time. METHODS: The software was developed in the Delphi integrated development environment and provides real-time image analysis during monitoring, based on image recognition of pain-related facial actions. To validate the software performance, facial images were obtained during the monitoring of 30 neonates who were subjected to painful procedures related to daily care management. Of the 5644 images identified and analysed by the software, 360 images - 12 per infant - were randomly selected and assessed by six healthcare professionals with experience of recognising neonatal pain. RESULTS: The agreement between the examiners and the software assessment was excellent (κ = 0.975). The software exhibited 85% sensitivity and 100% specificity in detecting neutral facial expressions in the resting state and 100% sensitivity and specificity in detecting pain during painful procedures. CONCLUSION: It is possible to assess neonatal procedural pain using computer software that has good sensitivity and specificity to detect facial movements.

Dolor en el trauma térmico / Pain in thermal trauma

La máxima agresión física que puede sufrir un ser humano son las quemaduras. Actualmente, en Chile se hospitalizan alrededor de 9.000 personas al año por quemaduras, con una tasa de mortalidad que ha ido en disminución en los últimos 20 años, por lo tanto la cantidad de pacientes sobrevivientes va en aumento. La IASP (Internacional Association for Study of Pain) definió el dolor en quemados como: "un dolor agudo y grave, que se produce al sufrir una quemadura y luego continuo con exacerbaciones que declinan gradualmente". El dolor en el trauma térmico está siempre presente, es de intensidad severa y prolongada en el tiempo, con una alta prevalencia de dolor crónico. Se sabe que el aumento en la intensidad se debe a que las quemaduras dañan gran cantidad de nociceptores, produciéndose una amplificación de la respuesta al dolor. Los opioides son el principal pilar en el tratamiento farmacológico. Es fundamental el buen manejo del dolor, para evitar el dolor patológico que aumentará el dolor crónico y con ello el desmedro de la vida personal de nuestros pacientes. Desafortunadamente el subtratamiento es una realidad, produciendo directamente un retraso en la recuperación de sus quemaduras y en la inserción social y laboral.

Burns are the greatest physical aggression that a human being can experience. In Chile, approximately 9000 patients are hospitalized annually due to burns, with a mortality rate that has decreased progressively in the last 20 years, which means that the amount of survivors is increasing. The IASP (International Association for Study of Pain) has defined pain in the burn patient as "an acute and severe pain produced by a burn that later continues with exacerbations that gradually decline". Pain in thermal trauna is always present, of severe intensity and prolonged in time, with a high prevalence of chronic pain. It is Known that the increase in intensity of pain is due to the damage of a great number of nociceptors, that produces an amplification of the response to pain. Opioids are the mainstay of pharmacologic treatment. Appropriate management of pain is fundamental to avoid pathologic pain that will increase the chronic pain and deteriorate the quality of life of our patients. Unfortunately undertreatment is a reality, retarding the healing of the burn wound, and the social and workplace reintegration.