Does noninvasive electrical stimulation of acupuncture points reduce heelstick pain in neonates?

Abstract

Aim Noninvasive electrical stimulation at acupuncture points (NESAP) for analgesia is used in children, but has not been widely studied in neonates. The purpose of this study was to determine if NESAP alone or in combination with sucrose relieved heelstick pain in neonates. Methods Term neonates (n=162) receiving routine heelsticks for newborn screening were enrolled following parental consent. All infants received facilitated tucking and nonnutritive sucking. Neonates were randomized to standard care, sucrose, NESAP, or sucrose plus NESAP. NESAP (3.5 mA, 10 Hz) or sham was administered over 4 acupuncture points. The Premature Infant Pain Profile (PIPP), heart rate variability (HRV), and salivary cortisol were used to measure heelstick pain. Results PIPP scores among all 4 treatment groups increased during heelstick, F (9,119) =1.95, p 0.05, and NESAP therapy had no significant effect on PIPP scores. However, PIPP scores from baseline to heelstick increased the most in the two groups not receiving sucrose (p<0.01). Mean PIPP scores remained below 5 during the heelstick in all four groups, indicating minimal or no pain. Differences in HRV and salivary cortisol among groups were insignificant. Conclusion NESAP at 3.5 mA, 10 Hz is not effective in relieving pain during heelsticks in neonates.

Magnetic noninvasive acupuncture for infant comfort (MAGNIFIC) – a single‐blinded randomised controlled pilot trial

“…MA has not previously been studied as an analgesic for neonatal procedural‐related pain. Previous studies have utilised different acupuncture modalities, including laser, acupressure and noninvasive electrical stimulation (NESAP) . Mitchell et al found that sucrose was the most important mitigating factor in reducing PIPP scores rather than NESAP in 162 full‐term newborn infants and that there were no differences in other markers of stress, such as heart rate variability or salivary cortisol levels .…”

“…Previous studies have utilised different acupuncture modalities, including laser, acupressure and noninvasive electrical stimulation (NESAP) (18)(19)(20)(21). Mitchell et al found that sucrose was the most important mitigating factor in reducing PIPP scores rather than NESAP in 162 full-term newborn infants and that there were no differences in other markers of stress, such as heart rate variability or salivary cortisol levels (19). Studies that have shown no difference in pain secondary to acupuncture have used acupuncture modalities applied to local (e.g.…”

“…There are now an increasing number of reports of the safety and efficacy of acupuncture in the NICU environment with a recent review concluding current evidence indicates acupuncture is safe for infants . However, some of these techniques may be difficult to incorporate into routine NICU care.…”

A Review on Non-Pharmacological Treatments for Pain Management in Newborn Infants

“…Acupuncture activates pressure points leading to analgesia by increasing endogenous endorphins [32]. Body acupuncture and pain management is well known with the spinal pain pathways being recruited for attenuation of pain signaling in needle acupuncture.…”

Highlights in this issue

“…Anitha Mitchell et al randomised 162 term neonates undergoing routine heelsticks to receive usual care, namely facilitated tucking and a pacifier, or usual care with the addition of either NESAP or oral sucrose or NESAP plus sucrose. The premature infant pain profile scores were measured before, during and after the heelstick, and these indicated that NESAP was ineffective in reducing procedural pain, but sucrose seemed to be effective .…”