Clown-care reduces pain in children with cerebral palsy undergoing recurrent botulinum toxin injections- A quasi-randomized controlled crossover study
Hilla Ben-Pazi, Avraham Cohen, Naama Kroyzer, Renana Lotem-Ophir, Yaakov Shvili, Gidon Winter, Lisa Deutsch, Yehuda Pollak, Hilla Ben-Pazi, Avraham Cohen, Naama Kroyzer, Renana Lotem-Ophir, Yaakov Shvili, Gidon Winter, Lisa Deutsch, Yehuda Pollak
Abstract
Objective: We investigated the impact of clown-care on pain in 45 children with cerebral palsy who underwent recurrent Botulinum-toxin injections (age 7.04± 4.68 years). Participants were randomized to receive either clown (n = 20) or standard (n = 25) -care.
Methods: Pain Visual-Analogue-Scale (range 1-5) was reported before and after procedures. Pain assessment was lower for children undergoing Botulinum-toxin injections with clown-care (2.89± 1.36) compared to standard-care (3.85± 1.39; p = 0.036) even though pain anticipated prior to procedures was similar (~3).
Findings: Children who underwent the first procedure with clown-care reported lower pain even after they crossed-over to the following procedure which was standard (p = 0.048). Carryover effect was more prominent in injection-naïve children (p = 0.019) and during multiple procedures (p = 0.009). Prior pain experience correlated with pain in subsequent procedures only when first experience was standard-care (p = 0.001).
Conclusions: Clown-care alleviated pain sensation during Botulinum-toxin injections and initial clown-care experience reduced pain during subsequent injections even though clowns were not present.
Trial registration: clinicaltrials.gov ID # NCT01377883.
Conflict of interest statement
Competing Interests: We have the following interests. Lisa Deutsch is the owner of Biostatistical Consulting. Payment to BioStats for statistical analysis was covered by Magi Foundation. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.
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Source: PubMed