Nonpharmacologic Management of Pain During Common Needle Puncture Procedures in Infants: Current Research Evidence and Practical Considerations: An Update

Peripheral intravenous cannulation is a widespread and often repeated experience for infants nursed in a neonatal unit. The procedure, involving pain and discomfort for the infant and anxiety for the parents, is associated with increased exposure to physiological and emotional stress. These stresses can adversely affect parent satisfaction, emotional well-being, and infant neurodevelopmental outcomes.

Interventions such as kangaroo mother care and skin-to-skin contact reduce overall stress experiences for parents and their infants and improve long-term outcomes. The practice challenge is ensuring the continuity of these supportive interventions during medical procedures that have traditionally interrupted parent-infant contact. This article provides a comprehensive overview of one Dutch neonatal unit's approach toward maintaining parent-infant skin-to-skin care during routine peripheral intravenous catheter insertion.

Parents' whose babies underwent surgery, completed five days of stay in the surgical neonatal intensive care unit (NICU) and were literate in English, participated in this exploratory cohort study. Parents provided written responses to two open-ended questions relating to their baby's pain management. Thematic analysis of data from 52 parents revealed four major themes: Information Resources; Communication Practices; Barriers to Parental Role; and Staff Appreciation. The majority of parents wanted information provided in different formats about how to recognise their babies' pain and how to comfort their babies in addition to discussions with clinicians. They also wanted the choice to stay with their baby during painful procedures. A barrier to this was COVID-19 restrictions. Twenty-nine percent of parents responded that no additional resources were required. The findings highlight the need to improve parent-focussed resources and clinician education to better inform and support parents' involvement in managing their babies' pain in the surgical NICU.

Heel stick sampling, which is a common procedure in newborns, causes acute pain, and parents are aware of this.

The current study aimed to investigate the effectiveness of maternal-targeted training on newborn pain management, addressing the use of nonpharmacological methods and anxiety.

The study is 2-arm, parallel-group randomized controlled trial. A total of 64 mothers were included in this study. Mothers were randomly allocated to each group; intervention (n:32) and control (n=:32). Training on nonpharmacological pain management in newborns was given to the mothers in the intervention group. Data were collected with an Introductory Information Form, Nonpharmacological Pain Management Use Checklist, and State-Trait Anxiety Inventory.

Nonpharmacological methods were used for the procedures in the control group and the intervention group, with an absolute difference of 68.8% between groups. The difference was statistically significant (p < 0.001) and had a large effect (d = −79.222; 95% CI, −9.365 to 670.143. There was no significant difference between the groups in terms of anxiety score (p = 0.558).

Demonstrates the clinical relevance and feasibility of training targeting maternal on neonatal pain management during the heel stick sampling procedure.

Practice Implications: When non-pharmacological methods in pain management of newborns were recommended by the nurse, maternal involvement in pain management increased significantly, suggesting that nurses have a key role in ensuring parental involvement.

Clinical Trial Registration: NCT05173662.

Heel stick sampling, a common procedure in newborns, causes acute pain.

This study aims to measure the outcome of five various non-pharmacologic pain relief groups; maternal voice, white noise, holding, maternal voice+holding, and white noise+holding.

The study is an open label, randomized controlled trial. A total of 178 newborns were included in this study. Newborns were randomly allocated to each group; white noise (n = 31), maternal voice (n = 31), holding (n = 30), white noise+holding (n = 29), maternal voice+holding (n = 28), and control (n = 29) interventions. Newborns' pain responses were evaluated using the Neonatal Infant Pain Scale (NIPS), and the Premature Infant Pain Profile (PIPP). The primary measured outcomes were the newborns' pain levels, while the secondary outcomes were the heart rate and changes in oxygen saturation. The mean values of pain in neonates between groups were evaluated one minute before (Phase1), during (Phase2), and one minute after (Phase3) the procedure.

The research results are given with comparisons in three time periods (Phase1, Phase2 and Phase3). White noise and white noise+holding were found to have the lowest mean NIPS and PIPP score (p < 0.001). The mean heart rate was found to be the lowest in the white noise+holding group (p < 0.001). There was no significant difference between the groups in terms of oxygen saturation score (p = 0.453).

The white noise+holding applied to newborns during heel stick sampling were effective in pain reduction. Nurses and midwives can use white noise+holding method.

These results contribute to the pain management of newborns.

Facial expression has been used as a parameter to assess neonatal pain as it is considered a fundamental communication channel.

To analyze the report of the filmic use of the facial expression of newborns undergoing painful procedures in clinical trials.

Integrative review carried out in the CINAHL, Pubmed® databases via MEDLINE, SCOPUS, LILACS, WEB OF SCIENCE and COCHRANE.

A total of 690 articles were identified and the final sample totaled 40 articles. Among the 40 studies, 10% did not report the phases of data collection in which the recording of facial expressions took place; 17.5% did not report in which stages of collection the videos were analyzed; 10% reported which software was used for analysis.

The studies did not follow a pattern in the reporting of the use of filming equipment. Reporting standardization in future studies will allow their reproducibility and comparability of their results.

Needle procedures are among the most common causes of pain and distress for individuals seeking health care. While needle pain is especially problematic for children needle pain and associated fear also has significant impact on adults and can lead to avoidance of appropriate medical care. Currently there is not a standard definition of needle pain. A taxonomy, or classification system, for acute needle pain would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public−private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks−American Pain Society−American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including needle pain. To accomplish this, a working group of experts in needle pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact and/or functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific needle pain. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of needle associated fear, are proposed to define the types of acute needle pain.

This article presents a taxonomy for acute needle pain. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients undergoing needle procedures.