A Review of CAM for Procedural Pain in Infancy: Part II. Other Interventions

Jennie C. I. Tsao; Subhadra Evans; Marcia Meldrum; Tamara Altman; Lonnie K. Zeltzer

Disclosures

Evid Based Complement Alternat Med. 2008;5(4):399-407. 

In This Article

Abstract and Introduction

Abstract

This article is the second in a two-part series reviewing the empirical evidence for complementary and alternative medicine (CAM) approaches for the management of pain related to medical procedures in infants up to 6 weeks of age. Part I of this series investigated the effects of sucrose with or without non-nutritive sucking (NNS). The present article examines other CAM interventions for procedural pain including music-based interventions, olfactory stimulation, kangaroo care and swaddling. Computerized databases were searched for relevant studies including prior reviews and primary trials. Preliminary support was revealed for the analgesic effects of the CAM modalities reviewed. However, the overall quality of the evidence for these approaches remains relatively weak. Additional well-designed trials incorporating rigorous methodology are required. Such investigations will assist in the development of evidence-based guidelines on the use of CAM interventions either alone or in concert with conventional approaches to provide safe, reliable analgesia for infant procedural pain.

Introduction

Recent evidence suggests that the popularity of complementary and alternative medicine (CAM) in pediatric populations is growing.[1] Estimated prevalence rates of CAM use in the general population of children across all age groups has varied from a low 2%[2] to 20-30%.[3,4] However, among children with chronic illnesses who do not always respond well to conventional treatments, such as cancer, rheumatoid arthritis and cystic fibrosis, CAM use has been reported at much higher rates, ranging from 30-73%.[5,6,7]

One limitation of these prior estimates is that rates of CAM use have not been reported separately for infants versus older children. As a result, it has been difficult to accurately estimate the prevalence of CAM use in infants. In a rare investigation, Bellas and colleagues[8] recently examined prevalence rates for consulting CAM practitioners according to the age of the child in Washington state (where private health insurance is mandated to provide coverage for CAM therapies). Using insurance claims data, Bellas et al. found that the rate of CAM consultation for infants (0-1 years) was 3.2%. The therapies most frequently administered to infants were chiropractic care (1.8%) and naturopathic medicine (1.4%), while very small numbers (≤0.1%) received acupuncture or massage. CAM usage rates were found to be similar between infants and children aged 2-5 years (3.0%). On the other hand, the use of CAM was found to increase among older children (6-12 years: 5%; 13-17 years: 9.8%). Children with back pain and cancer had the highest percentage of CAM use, but the prevalence of CAM use within these diagnoses was not analyzed by age. These findings indicate that CAM is being sought for a small percentage of infants, although the reasons for such CAM use were not specified.

Although there has been no systematic evaluation of the prevalence of CAM use for acute, procedural pain in hospitals and neonatal intensive care units (NICUs), a number of investigators have begun to examine the potential benefits of CAM for managing pain related to medical procedures in infants. In recent years, pediatricians, nurses and parents have raised increasing concerns about the number of painful medical procedures that infants, especially preterm neonates in the NICU, must undergo.[9] There is also growing concern about the potential risks of alleviating infant pain with conventional, pharmacologic agents. Thus, alternative, non-pharmacological approaches for the relief of procedural pain in these vulnerable patients have attracted new interest. Whereas there have been several previous reviews summarizing the literature on the efficacy of CAM approaches for acute and chronic pain in children,[10,11,12,13] relatively few reports have focused on infants. This article is the second in a two-part series reviewing available evidence on the efficacy of CAM interventions for relief of procedural pain in infants. Part I of this series examined sucrose, and other sweet substances with or without non-nutritive sucking (NNS). This article investigates other CAM modalities for the management of procedural pain in infancy. The authors were unable to identify investigations evaluating the use of CAM for other pain problems (e.g. organic pain) in this age group.

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