A Review of Non-Pharmacological Treatments for Pain Management in Newborn Infants

Avneet K Mangat, Ju-Lee Oei, Kerry Chen, Im Quah-Smith, Georg M Schmölzer, Avneet K Mangat, Ju-Lee Oei, Kerry Chen, Im Quah-Smith, Georg M Schmölzer

Abstract

Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods are ambiguous. The objective was to review the effectiveness and safety of non-pharmacological methods of pain relief in newborn infants and to identify those that are the most effective. PubMed and Google Scholar were searched using the terms: "infant", "premature", "pain", "acupuncture", "skin-to-skin contact", "sucrose", "massage", "musical therapy" and 'breastfeeding'. We included 24 studies assessing different methods of non-pharmacological analgesic techniques. Most resulted in some degree of analgesia but many were ineffective and some were even detrimental. Sucrose, for example, was often ineffective but was more effective than music therapy, massage, breast milk (for extremely premature infants) or non-invasive electrical stimulation acupuncture. There were also conflicting results for acupuncture, skin-to-skin care and musical therapy. Most non-pharmacological methods of analgesia provide a modicum of relief for preterm infants, but none are completely effective and there is no clearly superior method. Study is also required to assess potential long-term consequences of any of these methods.

Keywords: acupuncture; breastfeeding; infant; massage; musical therapy; pain; premature; skin-to-skin contact; sucrose.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Cignacco E., Hamers J.P., Stoffel L., Lingen R.A., Gessler P., McDougall J., Nelle M. The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. Eur. J. Pain. 2007;11:139–152. doi: 10.1016/j.ejpain.2006.02.010.
    1. Saad H.H., Bours G.J.J.W., Stevens B., Hamers J.P.H. Assessment of pain in the neonate. Semin. Perinatol. 1998;22:402–416. doi: 10.1016/S0146-0005(98)80056-6.
    1. Barker D.P., Rutter N. Exposure to invasive procedures in neonatal intensive care unit admissions. Arch. Dis. Child.-Fetal Neonatal Ed. 1995;72:47–48. doi: 10.1136/fn.72.1.F47.
    1. Meaney M.J., Aitken D.H. The effects of early postnatal handling on hippocampal glucocorticoid receptor concentrations: Temporal parameters. Brain Res. 1985;354:301–304. doi: 10.1016/0165-3806(85)90183-X.
    1. Taddio A., Katz J., Ilersich A.L., Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1997;349:599–603. doi: 10.1016/S0140-6736(96)10316-0.
    1. American and Canadian Academy of Pediatrics Prevention and management of pain and stress in the neonate. Pediatrics. 2000;15:454–461.
    1. Taddio A. Opioid analgesia for infants in the neonatal intensive care unit. Clin. Perinatol. 2002;29:493–509. doi: 10.1016/S0095-5108(02)00017-9.
    1. Melzack R., Wall P.D. Pain mechanism: A new theory. Science. 1965;150:971–979. doi: 10.1126/science.150.3699.971.
    1. Shabani F., Nayeri N.D., Karimi R., Zarei K., Chehrazi M. Effects of music therapy on pain responses induced by blood sampling in premature infants: A randomized cross-over trial. Iran. J. Nurs. Midwifery Res. 2016;21:391–396.
    1. Seo Y.S., Lee J., Ahn H.Y. Effects of Kangaroo Care on Neonatal Pain in South Korea. J. Trop. Pediatr. 2016;62:246–249. doi: 10.1093/tropej/fmv102.
    1. Freire N.B., Garcia J.B., Lamy Z.C. Evaluation of analgesic effect of skin-to-skin contact compared to oral glucose in preterm neonates. Pain. 2008;139:28–33. doi: 10.1016/j.pain.2008.02.031.
    1. Olsson E., Ahlsén G., Eriksson M. Skin-to-skin contact reduces near-infrared spectroscopy pain responses in premature infants during blood sampling. Acta Paediatr. 2016;105:376–380. doi: 10.1111/apa.13180.
    1. Efendi D., Rustina Y., Gayatri D. Pacifier and swaddling effective in impeding premature infant’s pain score and heart rate. Enferm. Clin. 2018;1:46–50. doi: 10.1016/S1130-8621(18)30035-4.
    1. Erkut Z., Yildiz S. The Effect of Swaddling on Pain, Vital Signs, and Crying Duration during Heel Lance in Newborns. Pain Manag. Nurs. 2017;18:328–336. doi: 10.1016/j.pmn.2017.05.007.
    1. Ho L.P., Ho S.S., Leung D.Y., So W.K., Chan C.W. A feasibility and efficacy randomized controlled trial of swaddling for controlling procedural pain in preterm infants. J. Clin. Nurs. 2016;25:472–482. doi: 10.1111/jocn.13075.
    1. Axelin A., Salanteräa S., Lehtonenb L. Facilitated tucking by parents’ in pain management of preterm infants—A randomized crossover trial. Early Hum. Dev. 2006;8:241–247. doi: 10.1016/j.earlhumdev.2005.09.012.
    1. Arikan D., Alp H., Gözüm S., Orbak Z., Cifçi E.K. Effectiveness of massage, sucrose solution, herbal tea or hydrolysed formula in the treatment of infantile colic. J. Clin. Nurs. 2008;17:1754–1761.
    1. Chik Y.M., Ip W.Y., Choi K.C. The Effect of Upper Limb Massage on Infants’ Venipuncture Pain. Pain Manag. Nurs. 2017;18:50–57. doi: 10.1016/j.pmn.2016.10.001.
    1. Jain S., Kumar P., McMillan D.D. Prior leg massage decreases pain responses to heel stick in preterm babies. J. Paediatr. Child Health. 2006;42:505–508. doi: 10.1111/j.1440-1754.2006.00912.x.
    1. Zhu J., Hong-Gu H., Zhou X., Wei H., Gao Y., Ye B., Liu Z., Chan S.W. Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: A randomized controlled trial. Midwifery. 2015;31:365–372. doi: 10.1016/j.midw.2014.11.001.
    1. Shah S.R., Kadage S., Sinn J. Trial of Music, Sucrose, and Combination Therapy for Pain Relief during Heel Prick Procedures in Neonates. J. Pediatr. 2017;190:153–158.e2. doi: 10.1016/j.jpeds.2017.08.003.
    1. Zurita-Cruz J.N., Rivas-Ruiz R., Gordillo-Álvarez V., Villasis-Keever M.Á. Breastfeeding for acute pain control on infants: A randomized controlled trial. Nutr. Hosp. 2017;34:301–307. doi: 10.20960/nh.163.
    1. Erkul M., Efe E. Efficacy of Breastfeeding on Babies’ Pain During Vaccinations. Breastfeed. Med. 2017;12:110–115. doi: 10.1089/bfm.2016.0141.
    1. Simonse E., Mulder P.G., van Beek R.H. Analgesic effect of breast milk versus sucrose for analgesia during heel lance in late preterm infants. Pediatrics. 2012;129:657–663. doi: 10.1542/peds.2011-2173.
    1. Baudesson de Chanville A., Brevaut-Malaty V., Garbi A., Tosello B., Baumstarck K., Gire C. Analgesic Effect of Maternal Human Milk Odor on Premature Neonates: A Randomized Controlled Trial. J. Hum. Lact. 2017;33:300–308. doi: 10.1177/0890334417693225.
    1. Zhao Z. Neural mechanism underlying acupuncture analgesia. Prog. Neurobiol. 2008;85:355–375. doi: 10.1016/j.pneurobio.2008.05.004.
    1. Chen K.L., Lindrea K.B., Quah-Smith I., Schmölzer G.M., Daly M., Schindler T., Oei J.L. Magnetic noninvasive acupuncture for infant comfort (MAGNIFIC)—A single-blinded randomised controlled pilot trial. Acta Paediatr. 2017;106:1780–1786. doi: 10.1111/apa.14002.
    1. Abbasoğlu A., Cabıoğlu M.T., Tuğcu A.U., İnce D.A., Tekindal M.A., Ecevit A., Tarcan A. Acupressure at BL60 and K3 Points Before Heel Lancing in Preterm Infants. EXPLORE J. Sci. Heal. 2015;11:363–366. doi: 10.1016/j.explore.2015.07.005.
    1. Lima A., Santos V., Nunes M., Barreto J., Ribeiro C., Carvalho J., Ribeiro M. Glucose solution is more effective in relieving pain in neonates than non-nutritive sucking: A randomized clinical trial. Eur. J. Pain. 2017;21:159–165. doi: 10.1002/ejp.912.
    1. Gouin S., Gaucher N., Lebel D., Desjardins M.P. A Randomized Double-Blind Trial Comparing the Effect on Pain of an Oral Sucrose Solution vs. Placebo in Children 1 to 3 Months Old Undergoing Simple Venipuncture. J. Emerg. Med. 2018;54:33–39. doi: 10.1016/j.jemermed.2017.08.015.
    1. Collados-Gómez L., Ferrera-Camacho P., Fernandez-Serran E., Camacho-Vicente V., Flores-Herrero C., García-Pozo A., Jiménez-García R. Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks. Acta Paediatr. 2018;107:436–441. doi: 10.1111/apa.14151.
    1. Hebb A.L., Poulin J.F., Roach S.P., Zacharko R.M., Drolet G. Cholecystokinin and endogenous opioid peptides: Interactive influence on pain, cognition, and emotion. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2005;29:1225–1238. doi: 10.1016/j.pnpbp.2005.08.008.
    1. Huang C.M., Tung W.S., Kuo L.L., Chang Y.J. Comparison of pain responses of premature infants to the heelstick between containment and swaddling. J. Nurs. Res. 2004;12:31–35. doi: 10.1097/01.JNR.0000387486.78685.c5.
    1. Esfahani M.S., Sheykhi S., Abdeyazdan Z., Jodakee M., Boroumandfar K. A comparative study on vaccination pain in the methods of massage therapy and mothers’ breastfeeding during injection of infants referring to Navabsafavi Health Care Center in Isfahan. Iran. J. Nurs. Midwifery Res. 2013;18:494–498.
    1. Bellieni C.V., Buonocore G., Nenci A., Franci N., Cordelli D.M., Bagnoli F. Sensorial saturation: An effective analgesic tool for heel-prick in preterm infants. Neonatology. 2001;80:15–18. doi: 10.1159/000047113.
    1. Yurkovich J., Burns D.S., Harrison T. The Effect of Music Therapy Entrainment on Physiologic Measures of Infants in the Cardiac Intensive Care Unit: Single Case Withdrawal Pilot Study. J. Music Ther. 2018;55:62–82. doi: 10.1093/jmt/thx017.
    1. Olischar M., Shoemark H., Holton T., Weninger M., Hunt R.W. The influence of music on aEEG activity in neurologically healthy newborns ≥32 weeks’ gestational age. Acta Paediatr. 2011;100:670–675. doi: 10.1111/j.1651-2227.2011.02171.x.
    1. Porter R.H., Winberg J. Unique salience of maternal breast odors for newborn infants. Neurosci. Biobehav. Rev. 1999;23:439–449. doi: 10.1016/S0149-7634(98)00044-X.
    1. Lima A.H., Hermont A.P., Friche A.A.L. Analgesia in newborns: A case-control study of the efficacy of nutritive and non-nutritive sucking stimuli. CoDAS. 2013;25:365–368. doi: 10.1590/S2317-17822013005000002.
    1. Napadow V., Ahn A., Longhurst J., Lao L., Stener-Victorin E., Harris R., Langevin H.M. The status and future of acupuncture mechanism research. J. Altern. Complement. Med. 2008;14:861–869. doi: 10.1089/acm.2008.SAR-3.
    1. Quah-Smith I., Sachdev P.S., Wen W., Chen X., Williams M.A. The Brain Effects of Laser Acupuncture in Healthy Individuals: An fMRI Investigation. PLoS ONE. 2010;5:e12619. doi: 10.1371/journal.pone.0012619.
    1. Cho Z.H., Oleson T.D., Alimi D., Niemtzow R.C. Acupuncture: The search for biologic evidence with functional magnetic resonance imaging and positron emission tomography techniques. J. Altern. Complement. Med. 2002;8:399–401. doi: 10.1089/107555302760253577.
    1. Mitchell A.J., Hall R.W., Golianu B., Yates C., Williams D.K., Chang J., Anand K.J. Does noninvasive electrical stimulation of acupuncture points reduce heelstick pain in neonates? Acta Paediatr. 2016;105:1434–1439. doi: 10.1111/apa.13581.
    1. Holsti L., Grunau R.E. Considerations for using sucrose to reduce procedural pain in preterm infants. Pediatrics. 2010;125:1042–1047. doi: 10.1542/peds.2009-2445.
    1. Blass E.M., Ciaramitaro V. A new look at some old mechanisms in newborns: Taste and tactile determinants of state, affect and action. Monogr. Soc. Child Dev. 1994;59:1–81. doi: 10.2307/1166096.
    1. Marceau J.R., Murray H., Nanan R.K. Efficacy of oral sucrose in infants of methadone-maintained mothers. Neonatology. 2010;97:67–70. doi: 10.1159/000231519.
    1. Asmerom Y., Slater L., Boskovic D.S., Bahjri K., Holden M.S., Phillips R., Deming D., Ashwal S., Fayard E., Angeles D.M. Oral sucrose for heel lance increases adenosine triphosphate use and oxidative stress in preterm neonates. J. Pediatr. 2013;163:29–35. doi: 10.1016/j.jpeds.2012.12.088.
    1. Nuseir K.Q., Alzoubi K.H., Alabwaini J., Khabour O.F., Kassab M.I. Sucrose-induced analgesia during early life modulates adulthood learning and memory formation. Physiol. Behav. 2015;145:84–90. doi: 10.1016/j.physbeh.2015.04.002.
    1. Siuciak J.A., Wong V., Perasall D., Weigand S.J., Lindsay R.M. BDNF produces analgesia in the formalin test and modifies neuropeptide levels in rat brain and spinal cord areas associated with nociception. Eur. J. Neurosci. 1995;7:663–670. doi: 10.1111/j.1460-9568.1995.tb00670.x.
    1. Zhang H., Torregrossa M.M., Jutkiewica E.M. Endogenous opioids upregulate brain-derived neurotrophic factor mRNA through delta- and micro-opioid receptors independent of antidepressant-like effects. Eur. J. Neurosci. 2006;23:984–994. doi: 10.1111/j.1460-9568.2006.04621.x.
    1. Feldman-Winter L., Goldsmith J.P. Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns. Pediatrics. 2016;138:e20161889. doi: 10.1542/peds.2016-1889.
    1. Yates C.C., Mitchell A.J., Lowe L.M., Lee A., Hall R.W. Safety of Noninvasive Electrical Stimulation of Acupuncture Points During a Routine Neonatal Heel Stick. Med. Acupunct. 2013;25:285–290. doi: 10.1089/acu.2012.0952.

Source: PubMed

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