The Effect of Upper Limb Massage on Infants' Venipuncture Pain

Yuen-Man Chik, RN, BSN, MSc; Wan-Yim Ip, RN, RM, BN, MPhil, PhD; Kai-Chow Choi, BSc, PhD


Pain Manag Nurs. 2017;18(1):50-57. 

In This Article

Abstract and Introduction


The purpose of the study was to investigate the effect of upper limb massage on relieving pain among infants undergoing venipuncture in Hong Kong. This study was a crossover, double-blind, randomized controlled trial. Eighty infants at the neonatal intensive care unit were randomly assigned to 2 groups in different order to receive interventions. The massage first group (N = 40) received 2-minute massage before venipuncture on the first occasion then received usual care (control) on the second occasion, and vice versa in the massage second group (N = 40). The infants' behavior and physiological responses were recorded on two occasions: (1) right after the intervention and (2) during the first 30 seconds of venipuncture procedure. The mean pain scores (Premature Infant Pain Profile) were significantly lower in infants who received massage (massage first: 6.0 [standard deviation = 3.3]; massage second: 7.30 [standard deviation = 4.4]) versus control (massage first: 12.0 [standard deviation = 4.3]; massage second: 12.7 [standard deviation = 3.1]). The crude and adjusted generalized estimating equations model showed that the infants had significantly lower pain score when receiving massage as compared to receiving the control treatment, and there were no significant time and carryover effects: −6.03 (95% confidence interval: −7.67 to −4.38), p < .001 and −5.96 (95% confidence interval: −7.56 to −4.36), p < .001, respectively. Upper limb massage may be effective in decreasing infants' venipuncture pain perception.


Infants appear to be particularly vulnerable to the negative effects of pain (Ahn, 2006; Anand & Scalzo, 2000; Evans, McCartney, Lawhon, & Galloway, 2005; Grunau, Holsti, & Peters, 2006; Smith, 2012), and they may undergo many invasive and painful procedures during hospitalization for various medical reasons (Carbajal et al, 2008; Johnston, Barrington, Taddio, Carbajal, & Filion, 2011; Porter, Wolf, & Miller, 1999; Simons et al., 2003). Blood sampling is one of the procedures often required in treating infants in clinical units, predominantly in screening tests for sepsis or other congenital illnesses.

In considering infant pain, venipuncture is believed to cause less pain than heel stick (Lago et al., 2009; Larsson, Tannfeldt, Lagercrantz, & Olsson, 1998; Mainous, 1999; Meek, 2012; Ogawa et al., 2005; Rao, 1998; Shah & Ohlsson, 2012; Shah, Taddio, Bennett, & Speidel, 1997). However, it is still a painful event for infants if they are not given appropriate analgesia or comfort measures (Byrd, Gonzales, & Parsons, 2009; Gibbins et al., 2002; Halimaa, 2003; Ismail & Gandhi, 2011; Losacco et al., 2011; Porter et al., 1999; Simons et al., 2003).

The limitations in infant pain management may result from lack of knowledge of infant pain reactivity (Stevens, Johnston, & Horton, 1994; Stevens, Johnston, Petryshen, & Taddio, 1996). Little attention has been given to the use of massage for pain relief in infants undergoing venipuncture, although massage has been reported to be an effective, nonpharmacological measure for the relief of procedural pain.

Some previous studies showed that massage had a therapeutic effect in relieving pain in infants undergoing heel stick. A trial by Jain, Kumar, and McMillan (2006), involving a two-minute massage of the ipsilateral leg, was carried out with 23 infants before they underwent a heel stick. The pain scores and heart rates were significantly elevated in the control group compared with those in the massage group. Bellieni et al. (2007) performed a study of sensorial saturation, which included massage: two intervention groups (from 66 infants, three groups in total) received sensorial saturation from nurses or their mothers before they underwent a heel stick, and one group received only oral glucose plus sucking. The results showed that infants in the sensorial saturation groups had lower pain levels than infants who received only oral glucose plus sucking. In a study by Abdallah, Badr, and Hawwari (2013), the 32 infants of the intervention group (from 66 stable, preterm infants) received massage therapy by their mothers. Infants who were massaged were shown to have significantly lower pain scores after a heel prick when compared to the control group.

To the best of our knowledge, no previous study has determined the effect of massage on relieving infant pain during venipuncture. The aim of this study, therefore, was to investigate the effects of massage on the relief of pain in infants undergoing venipuncture.