CPG for reducing pain associated with childhood immunizations

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NEW YORK (Reuters Health) Nov 22 – An interdisciplinary panel of experts from Canada has developed an evidence-based clinical practice guideline for reducing pain associated with childhood immunizations.

A summary of the guideline was published online November 22 in CMAJ.

Pain surrounding childhood immunizations can have long-term consequences, including preprocedural anxiety, hyperalgesia, needle fears and avoiding immunizations altogether, Dr. Anna Taddio, of the Hospital for Sick Children in Toronto and the “Help Eliminate Pain in Kids” panel note in their report.

They add that minimizing pain during childhood vaccination is important to help prevent these issues and there’s a need for clear guidance to address this “important public health issue.”

To that end, the HELPinKIDS panel evaluated 71 relevant studies including 8050 children and formulated a clinical practice guideline based on the “3-P” approach to pain management, including pharmacologic, physical and psychological strategies.

The scope of the guideline was limited to acute pain and distress at the time of vaccine injection in children 0 to 18 years old and is “generalizable to healthy children receiving immunization injections worldwide,” the authors say.

Several of the strategies found to be effective in relieving distress and pain of injections and recommended in the guideline can be implemented immediately, the authors say.

These include positioning the child upright when administering vaccines, injecting the most painful vaccine last when multiple injections are being administered, providing tactile stimulation, and performing intramuscular injections rapidly without prior aspiration.

Dr Taddio and colleagues write that “about one-third of vaccinators do not perform aspiration, and there have been no documented harms caused by omitting this step.”

Other evidence-based pain-relieving strategies contained in the guideline may require some planning or additional resources, or both, on the part of healthcare providers and children and their families. These include breastfeeding or administering sugar water (for infants) and applying a topical anesthetic and psychological interventions such as distraction (for children of all ages).

The authors acknowledge in their report that “at present, the optimal pain-relieving regimen for nullifying pain, rather than simply diminishing pain, is unknown.” They say additional research is needed to determine which pain-relieving regimens reliably prevent pain in children of different ages.

New vaccine administration technologies such as microneedles and needle-free administration techniques, such as nasal sprays, hold promise for reducing pain associated with vaccination administration.

Funding for the project was provided by the Canadian Institutes of Health Research.

CMAJ. Published online November 22, 2010. Abstract

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