Laird Harrison

May 25, 2012

May 25, 2012 (Honolulu, Hawaii) — Massaging infants' arms and hands and swaddling can both significantly reduce their pain from needle sticks, 2 new studies show.

In 1 study, researchers massaged the upper limbs of infants in a neonatal intensive care unit (NICU) before administering venipuncture for blood tests.

In the other study, researchers swaddled the infants in blankets before administering a heel stick.

Both research teams assessed the infants' pain on the Premature Infant Pain Profile (PIPP), a composite measure using heart rate, oxygen saturation, facial responses to pain (grimacing, brow bulge, nasolabial furrows, and pursed lips), behavioral state, and gestational age.

The researchers reported results of both studies at the American Pain Society (APS) 31st Annual Scientific Meeting..

Babies Suffering

Physicians frequently stick infants in a NICU with needles to test their blood or administer medication. "In my clinical practice I see so many babies suffering," Yuen Man Chik, MS, first author of the massage study, told Medscape Medical News, "so I wondered if there is any method to relieve pain."

It can be difficult to give infants oral analgesics, added Chik, a researcher at the United Christian Hospital in Hong Kong, China. "In foreign hospitals they like to use sucrose. It's effective in some ways, but in some babies it's not suitable because of the immature gut."

For the massage study, Chik and her colleagues randomly divided 65 infants with a gestational age between 30 and 40 weeks into 2 groups. The 32 infants in group 1 received a 2-minute massage before their first venipuncture. They got usual care before their second venipuncture.

In group 2, the sequence was reversed — usual care first, then massage.

Researchers recorded the infants' behavior and physiologic responses with a real-time counter right after the massage, and again during the first 30 seconds of the venipuncture procedure.

A nurse who did not know which infants had the massage before the venipuncture reviewed videos and biometrics of the infants and scored them on the PIPP. Scores on the PIPP range from 0 to 21, with the higher score indicating greater pain behavior.

The mean pain score in the first group was 5.84 ± 3.51 with massage and 12.66 ± 3.10 without massage. The respective scores in the second group were 7.30 ± 4.43 and 11.33 ± 4.37.

The researchers concluded that the technique effectively reduced the infants' pain. "After massage there was not so much crying," Chik added.

Kathleen Sluka, PhD, a professor of physical therapy and rehabilitation science pain at the University of Iowa in Iowa City told Medscape Medical News she was impressed that massaging seemed to cut pain scores by as much as half.

"That's a pretty big reduction in pain for something so simple as a 2-minute massage," said Sluka, who was not involved in the study. "That's really easy to do."

She said babies who experience pain are more likely to develop chronic pain as adults. "This could be really important from that perspective," she said.

Swaddling

In the second study, researchers from the Chinese University of Hong Kong in China investigated the effect of swaddling in premature newborns. They randomly assigned 27 premature infants to be swaddled and 27 to no intervention.

They report that the mean PIPP scores were lower in the intervention than the control group during; immediately after; and 2, 4, and 6 minutes after a heel stick (P = .001).

The mean heart rate and oxygen saturation were also lower in the intervention group than in the control group at all these time points (P < .001).

Both heart rate and oxygen saturation in the swaddled babies returned to the baseline level at 2 minutes, but it took 6 to 8 minutes for these rates to return to baseline in the control group.

The researchers did not document any adverse effects. They speculate that swaddling provides stimulation across the proprioceptive, thermal, and tactile sensory systems that may reduce pain through gate control mechanisms.

Swaddling could be less practical than massaging because it is hard to get access to the veins of babies wrapped in blankets, Chik pointed out.

American Pain Society (APS) 31st Annual Scientific Meeting. Abstract #333 and #455. Presented May 16, 2012.

Ms. Chik and Ms. Sluka have disclosed no relevant financial relationships.

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