Analysis of two non-pharmacological pain management methods for vaccine injection pain in infants: A randomized controlled trial

Objectives: This study was performed to investigate the efficiency of local heat and cold application to decrease vaccineassociated pain among infants 2–6 months of age. Methods: This was a randomized controlled trial. The study universe comprised infants aged 2–6 months who were brought to 4 family health centers in the Safranbolu district of Karabuk Province, Turkey, for a pneumococcal vaccination June 1-November 30, 2016. A total of 96 infants (heat application: 31, cold application: 32, and control group: 33) were enrolled in the the study. The data were collected using an infant ınformation form and the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale. Results: The mean FLACC score of the infants was 5.531±1.934 in the cold application group, 8.710±1.346 in the heat application group, and 9.152±1.661 in the control group. The difference between the mean scores of the groups was statistically significant (KW=49.043; p=0.000). Conclusion: Local cold and heat application methods applied to the vaccination area before a pneumoccal vaccine reduced vaccine-associated pain in the infants, and the application of cold was more effective than heat.

Bebeklerde aşı enjeksiyonu ağrısında iki non-farmokolojik ağrı yönetim metodu: Randomize kontrollü bir çalışma

Amaç: Bu çalışma 2–6 aylık bebeklerde aşıya bağlı gelişen ağrıyı azaltmada lokal sıcak ve soğuk uygulamanın etkinliğini araştırmak için yapıldı. Gereç ve Yöntem: Randomize kontrollü bir çalışmadır. Çalışmanın evrenini, pnömokok aşısı olmak için 1 Haziran–30 Kasım 2016 tarihleri arasında Karabük’ün Safranbolu ilçesinde bulunan dört aile sağlığı merkezine getirilen 2–6 aylık bebekler oluşturdu. Çalışmanın örneklemine toplam 96 bebek (sıcak uygulama: 31; soğuk uygulama: 32; kontrol grubu: 33) alındı. Veriler “Bebek Bigi Formu” ve FLACC Ağrı Ölçeği ile toplandı. Bulgular: Çalışmada, bebeklerin ortalama FLACC Ağrı Ölçeği skoru soğuk uygulama grubunda 5.531±1.934, sıcak uygulama grubunda 8.710±1.346 ve kontrol grubunda 9.152±1.661 idi. Grupların ortalama puanları arasındaki farkın istatistiksel olarak anlamlı olduğu bulundu (KW=49.043; p =0.000

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1. IASP. IASP Terminology. Available at: https://www.iasppain.org/terminology?navItemNumber=576. Accessed June 10, 2017.

2. Derebent E, Yiğit R. Pain in newborn: assesment and management. Journal of Cumhuriyet University School of Nursing 2006;10(2):41–8. [Article in Turkish]

3. Van de Velde M, Jani J, De Buck F, Deprest J. Fetal pain perception and pain management. Semin Fetal Neonatal Med 2006;11(4):232–6.

4. Felt BT, Mollen E, Diaz S, Renaud E, Zeglis M, Wheatcroft G, et al. Behavioral interventions reduce infant distress at immunization. Arch Pediatr Adolesc Med 2000;154(7):719–24.

5. Harrison D, Evans C, Johnston L, Loughnan P. Bedside assessment of heel lance pain in the hospitalized infant. J Obstet Gynecol Neonatal Nurs 2002;31(5):551–7.

6. Johnston CC, Fernandes AM, Campbell-Yeo M. Pain in neonates is different. Pain 2011;152(3 Suppl):S65–73.

7. Özel A, Çetin H. Effects of vibrating tourniquet application on the pain felt for blood drawing in pediatric patients. Agri. 2020;32(1):25–30. [Article in Turkish]

8. Caglayan N, Balci S. An effective model of reducing pain in preterm neonates: facilitated tucking. Florence Nightingale Journal of Nursing 2014;22(1):63–8. [Article in Turkish]

9. Tansky C, Lindberg CE. Breastfeeding as a pain intervention when immunizing infants. J Nurse Pract 2010;6(4):287–95.

10. Ozveren H. Non-pharmacological methods at pain management. Hacettepe University Faculty of Health Sciences Nursing Journal 2011;18(1):83–92. [Article in Turkish]

11. Inal S, Canbulat N. Using of distraction methods on procedural pain management of pediatric patient. Journal of Health Science and Profession 2015;2(3):372–8. [Article in Turkish]

12. Roykulcharoen V, Good M. Systematic relaxation to relieve postoperative pain. J Adv Nurs 2004;48(2):140–8.

13. Gol I, Onarici M. Nurses’ knowledge and practices about pain and pain control in children. Journal of Hacettepe University Faculty of Nursing 2015;2(3):20–9. [Article in Turkish]

14. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. A Cochrane review of superficial heat or cold for low back pain. Spine (Phila Pa 1976) 2006;31(9):998–1006.

15. Garra G, Singer AJ, Leno R, Taira BR, Gupta N, Mathaikutty B, et al. Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Acad Emerg Med 2010;17(5):484–9.

16. Kuzu N, Ucar H. The effect of cold on the occurrence of bruising, haematoma and pain at the injection site in subcutaneous low molecular weight heparin. Int J Nurs Stud 2001;38(1):51–9.

17. Hasanpour M, Tootoonchi M, Aein F, Yadegarfar G. The effects of two non-pharmacologic pain management methods for intramuscular injection pain in children. Acute Pain 2006;8(1):7–12.

18. Curry DM, Brown C, Wrona S. Effectiveness of oral sucrose for pain management in infants during immunizations. Pain Manag Nurs 2012;13(3):139–49.

19. Karaman E, Dogru BV, Yildirim Y. Knowledge and attitudes of nursing students about pain management. Agri 2019;31(2):70–8.

20. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 1997;23(3):293–7.

21. Senayli Y, Ozkan F, Senayli A, Bicakci U. Evaluation of postoperative pain in children with FLACC Pain Scale in Turkish translation. Turkiye Klinikleri J Anest Reanim 2006;4(1):1–4. [Article in Turkish]

22. Franck LS, Greenberg CS, Stevens B. Pain assessment in infants and children. Pediatr Clin North Am 2000;47(3):487– 512.

23. Valeri BO, Linhares MBM. Pain in preterm infants: Effects of sex, gestational age, and neonatal illness severity. Psychology and Neuroscience 2012;5(1):11–9.

24. Farhadi A, Esmailzadeh, M. Effect of local cold on intensity of pain due to Penicillin Benzathin intramuscular injection. Int J Med Med Sci 2010;3(11):343–6.

25. Ramadan RH, El-Fouly YA, Sharaf WE, Ayoub AS. Effect of cryotherapy on pain intensity among adult patients receiving intramuscular injections. IOSR-JNHS 2016;5(2):1–10.

26. Biyik Bayram S, Caliskan N. Effects of local heat application before intravenous catheter insertion in chemotherapy patients. J Clin Nurs 2016;25(11-12):1740–7.

27. Kwekkeboom KL, Gretarsdottir E. Systematic review of relaxation interventions for pain. J Nurs Scholarsh 2006;38(3):269–77.

28. Yagiz On A. Cold applications for the treatment of pain. Agri 2006;18(2):5-14. [Article in Turkish]

29. Ozdemir FK, Tüfekci FG. The effect of using musical mobiles on reducing pain in infants during vaccination. J Res Med Sci 2012;17(7):662–7.

30. Guinsburg R, de Araújo Peres C, Branco de Almeida MF, de Cássia Xavier Balda R, Cássia Berenguel R, Tonelotto J, et al. Differences in pain expression between male and female newborn infants. Pain 2000;85(1-2):127–33.

31. Koçoğlu D, Özdemir L. The relation between pain and pain beliefs with socio-demographic-economic characteristics at the adult population. Agri 2011;23(2):64–70. [Article in Turkish]

32. Jacobson RM, Swan A, Adegbenro A, Ludington SL, Wollan PC, Poland GA; Vaccine Research Group. Making vaccines more acceptable--methods to prevent and minimize pain and other common adverse events associated with vaccines. Vaccine 2001;19(17-19):2418–27.

33. Göl İ, Altuğ Özsoy S. Effects of Rapid Vaccine Injection Without Aspiration and Applying Manual Pressure Before Vaccination on Pain and Crying Time in Infants. Worldviews Evid Based Nurs 2017;14(2):154–62.