Pharmacological and Combined Interventions to Reduce Vaccine Injection Pain in Children and Adults

Shah, Vibhuti; Taddio, Anna; McMurtry, C. Meghan; Halperin, Scott A.; Noel, Melanie; Riddell, Rebecca Pillai; Chambers, Christine T.

doi:10.1097/ajp.0000000000000281

Cited by 96 publications

(76 citation statements)

References 95 publications

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“…21 The observed effect size (SMD between groups), however, was lower in the present study (0.5 v. 0.9). Design features such as concomitant use of cointerventions (e.g., order of injection, no aspiration) and longitudinal approach may partially Baseline*, mo 2 3.0 ± 1.3 3.1 ± 1.4 2.9 ± 1.3 2.8 ± 1.2 4 2.6 ± 1.1 2.4 ± 0.8 2.4 ± 0.9 2.3 ± 0.8 6 2.4 ± 0.8 2.2 ± 0.5 2.3 ± 0.7 2.4 ± 0.7 12 2.7 ± 1.3 § 2.8 ± 1.3 2.7 ± 1.3 2.7 ± 1.3…”

Section: Discussioncontrasting

confidence: 52%

Section: Discussioncontrasting

confidence: 52%

“…In a recent meta -analysis, we showed a dose-response effect with a consistent benefit observed for strengths of 50%-75%, whereas mixed results were seen for strengths between 20% and 33%. 21 The strength used in the present study (24%) may have been insufficient to reliably confer a benefit. In addition, it is possible the effectiveness of sucrose wanes after the neonatal period.…”

Section: Researchmentioning

confidence: 80%

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Relative effectiveness of additive pain interventions during vaccination in infants

Taddio

Riddell

Ipp

et al. 2016

CMAJ

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MethodsWe conducted a multicentre, longitudinal, double-blind, doubledummy, add-on, randomized controlled trial. Healthy infants receiving vaccinations in 3 pediatric outpatient clinics, including 7 physician practices in Toronto were eligible. We excluded infants born before 36 weeks' gestation, infants who had stayed in hospital outside of postnatal care, and infants who were allergic to amide ABSTRACT BACKGROUND: Vaccine injections can cause acute pain and distress in infants, which can contribute to dissatisfaction with the vaccination experience and vaccine hesitancy. We sought to compare the effectiveness of additive pain interventions administered consistently during vaccine injections in the first year of life. RESEARCH Relative effectiveness of additive pain interventions during vaccination in infantsAnna METHODS:We conducted a multicentre, longitudinal, double-blind, add-on, randomized controlled trial. Healthy infants were randomly assigned to 1 of 4 levels of pain management for all vaccine injections at 2, 4, 6 and 12 months: (i) placebo control; (ii) parent-directed video education about infant soothing; (iii) the video plus sucrose administered orally or (iv) the video plus sucrose plus liposomal lidocaine applied topically. All infants benefit from injection techniques that minimize pain. We used a doubledummy design; hence all parents watched a video (active psychological intervention or placebo) and all infants received oral solution (sucrose or placebo) and topical cream (lidocaine or placebo). We assessed infant distress during 3 phases -preinjection (baseline), vaccine injection (needle), and 1 minute postinjection (recovery) -using the Modified Behavioural Pain Scale (range 0-10). We compared scores between groups and across infant ages using a mixed-model repeated-measures analysis. RESULTS:A total of 352 infants participated in the study, from Jan. 17, 2012, to Feb. 2, 2016. Demographics did not differ among intervention groups (p > 0.05). Baseline pain scores did not differ among intervention groups (p = 0.4), but did differ across ages (p < 0.001). Needle pain scores differed among groups (p = 0.003) and across ages (p < 0.001). The mean (± standard deviation) needle score was 6.3 (± 0.8) in the video-sucrose-lidocaine group compared with 6.7 (± 0.8) in each of the other groups. There were no other between-group differences. Recovery scores did not differ among groups (p = 0.98), but did differ across ages (p < 0.001). INTERPRETATION:Only liposomal lidocaine provided consistent analgesia within an additive pain intervention regimen during vaccinations in infants. Trial registration: ClinicalTrials.gov, no. NCT01503060 RESEARCH E228CMAJ | FEBRUARY 13, 2017 | VOLUME 189 | ISSUE 6anesthetics or vaccines and for whom mothers planned to use topical anesthetics, sucrose or breast feeding during vaccinations. Infants were randomly assigned to 1 of 4 pain-relieving regimens for all vaccine injections in their first year of life: (i) placebo control; (ii) parent-directed video education about i...

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Section: Discussioncontrasting

confidence: 52%

Section: Discussioncontrasting

confidence: 52%

Section: Researchmentioning

confidence: 80%

See 1 more Smart Citation

Relative effectiveness of additive pain interventions during vaccination in infants

Taddio

Riddell

Ipp

et al. 2016

CMAJ

Self Cite

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“…In a meta-analysis including 1424 children undergoing vaccination, there was a sub- stantial benefit of topical anesthetics on acute distress (SMD -0.91, 95% CI -1.36 to -0.47). 9 There is no evidence of an adverse effect of topical anesthetics on the vaccine immune response. 9 The provision of topical anesthetics should be a standard preventive measure for children, who cannot advocate for themselves and are at risk of long-term harm from unmitigated pain due to the development of needle fears.…”

Section: Pharmacologic Interventions (Pain Medicine)mentioning

confidence: 99%

“…A meta-analysis including 792 infants showed a large benefit of breastfeeding during vaccination (SMD -1.78, 95% CI -2.35 to -1.22). 9 Breastfeeding is a costneutral intervention and does not require additional time beyond the need to latch the infant. Some privacy and a chair are suggested.…”

Section: Physical Interventions (Body Position and Activity) We Recommentioning

confidence: 99%

Reducing pain during vaccine injections: clinical practice guideline

Taddio

McMurtry

Shah

et al. 2015

CMAJ

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188

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• Pain at the time of vaccine injection is a common concern and contributes to vaccine hesitancy across the lifespan.• Evidence-based and feasible interventions are available to mitigate pain and are part of good vaccination clinical practice.• This guideline includes recommendations for pain mitigation based on five domains of pain management interventions (procedural, physical, pharmacologic, psychological and process): the "5P" approach.

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Breastfeeding for procedural pain in infants beyond the neonatal period

Harrison

Reszel

Bueno

et al. 2016

Cochrane Database of Systematic Reviews

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We conclude, based on the 10 studies included in this review, that breastfeeding may help reduce pain during vaccination for infants beyond the neonatal period. Breastfeeding consistently reduced behavioural responses of cry duration and composite pain scores during and following vaccinations. However, there was no evidence that breastfeeding had an effect on physiological responses. No studies included in this review involved populations of hospitalised infants undergoing other skin-breaking procedures. Although it may be possible to extrapolate the review results to this population, further studies of efficacy, feasibility, and acceptability in this population are warranted.

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Pharmacological and Combined Interventions to Reduce Vaccine Injection Pain in Children and Adults

Abstract: Supplemental Digital Content is available in the text.

Cited by 96 publications

References 95 publications

Relative effectiveness of additive pain interventions during vaccination in infants

Relative effectiveness of additive pain interventions during vaccination in infants

Reducing pain during vaccine injections: clinical practice guideline

Breastfeeding for procedural pain in infants beyond the neonatal period

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