An Evaluation of the Efficacy of Selected Nonpharmacologic Pain Interventions in Infants

Infants subjected to painful stimuli respond with deleterious physiologic and metabolic effects, behavioral changes, and potentially long term effects on painful stimuli processing and response. There are few studies that address effective pain interventions for infants, particularly those interventions that staff nurses can implement independently. Interventions must be identified and their effectiveness must be validated for this vulnerable population. Pharmacologic management of pain may cause deleterious side effects and needs to be ordered by physicians or nurse practitioners. Nonpharmacologic methods to manage pain can usually be implemented by staff nurses independently. This study evaluated the efficacy of two nonpharmacologic pain management interventions, sucking and sucrose, and their ability to potentiate each other. This study is based on the Gate Control Theory of pain which posits that benign stimuli, such as sucking, send messages to the central nervous system that compete with painful stimuli to decrease the amount of pain perceived. Sucrose is thought to be mediated through opioid pathways. A sucrose coated pacifier may reduce pain via two pathways, thus being more effective than uni-modal techniques. A randomized, complete block, experimental design was used to evaluate the pain reduction efficacy of a: sucrose coated pacifier, oral sucrose solution, water moistened pacifier, and no intervention. Eighty-four neonates undergoing the painful procedure of heelstick were studied. Pain measures were duration of cry, vagal tone, and salivary cortisol. MANOVA revealed that the sucrose coated pacifier group cried significantly less than the water moistened pacifier and control groups. ANCOVA demonstrated significant covariation of birth weight with cortisol and procedure length with cry, neither covariate impacted treatment main effects. Repeated measures ANOVA revealed that the sucrose coated pacifier group demonstrated significantly lower vagal tone during heelstick than did the oral sucrose solution and no intervention groups. This significant difference persisted for 15 minutes post heelstick between the sucrose coated pacifier and no intervention groups. In summary, this study demonstrated the clinical efficacy of offering a sucrose coated pacifier to manage pain during heelstick in healthy neonates