Friday, November 12, 2010

Hold the Patient; Help the Pain?

Briefly Noted For newborn infants, being held and swaddled appears to be a simple and effective way to reduce acute pain during routine but painful procedures, according to new research. This raises a simple and important question: Would being held and comforted also be helpful for minimizing pain during procedures in children and adults?

Writing in the November/December issue of MCN: The American Journal of Maternal/Child Nursing, Carla Morrow, DNP, CNM, RN, of Texas Health Harris Methodist Hospital Cleburne, Cleburne, Texas, and colleagues report on 42 newborns undergoing a heel-lancing procedure for collecting blood samples and randomly assigned to either (a) the standard approach with the infant lying in a crib, or (b) being swaddled and held upright during the procedure [Morrow et al. 2010]. Using a standard pain assessment scale based on observable behaviors (facial expressions, crying, etc.) being held and swaddled reduced pain scores by more than half (52%). Time to collect blood samples also was reduced by the upright position but differences between groups on this were not significant.

Morrow and coauthors note that any pain relief afforded newborns can be important for avoiding development of an exaggerated pain response as well as longer-term developmental consequences. Certain other nondrug procedures also have been shown to reduce pain during procedures such as heel lancing — eg, a pacifier dipped in a sucrose solution — however, many hospitals do not routinely use such approaches even though they incur no cost and little time.

PRACTICE POINTER: This research study grabbed our attention because it makes so much common sense that human touch — holding and comforting — might stir innate feelings that reduce negative perceptions of a physically painful experience, and this apparently takes hold at birth. While wrapping adults, or even children, in a blanket, holding them, and offering something sweet to suck on during an acutely painful procedure might not be well-received, it seems worthwhile to consider how strategies of human (and humane) touch and comforting might be employed more effectively during everyday clinical practice for reducing fear, anxiety, and pain. Certainly, there would be no cost and little time involved; however, knowing what to do and how to do it is another matter.

REFERENCE Morrow C, Hidinger A, Wilkinson-Faulk D. Reducing Neonatal Pain During Routine Heel Lance Procedures. MCN, Amer J Maternal Child Nurs. 2010(Nov/Dec);35(6):346-354 [abstract here].