Journal of Pain and Symptom Management
Volume 10, Issue 8 , Pages 584-590, November 1995

The use of a topical refrigerant anesthetic to reduce injection pain in children

  • Karen Abbott, MN

      Affiliations

    • Department of Medicine (K.A.), Foothills Hospital, Calgary, Alberta ,Canada
    • ,
  • Susan Fowler-Kerry, PhD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to: Susan Fowler-Kerry, PhD, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 0W0
    • College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Accepted 31 March 1995.

Article Outline

Abstract 

Early childhood experiences with painful injections may lead to anxiety and fear. These reactions need not develop if steps are taken to reduce the pain associated with injections. The purpose of this study was to assess the efficacy of a refrigerant topical anesthetic in reducing injection pain in preschool children experiencing routine diphtheria-pertussis-tetanus (DPT) immunizations. This double-blind placebo-controlled study was conducted in community health clinics in conjunction with ongoing immunization programs. Ninety subjects, aged 4–5.5 years, were randomly assigned to one of three groups; (a) refrigerant topical anesthetic; (b) placebo topical spray; and (c) no-spray control. Pain was measured subjectively using a four-point visual analogue scale. Both the refrigerant topical anesthetic spray and the placebo spray significantly reduced injection pain. Age was found to be an important factor influencing pain response in this study. Parental anxiety was not a significant factor influencing pain response. In addition, parents were not good at predicting their child's pain. The results of the study support the use of an intervention, such as refrigerant topical anesthetic, as a practical, simple, and effective treatment strategy for reduction of short-term painful procedures like injections.

Keywords:  Injection pain, topical anesthetics, preschool

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Fradet C, McGrath PJ, Kay J, Adams S, Luke B. A prospective survey of reactions to blood tests by children and adolescents. Pain. 1990;40:53–60
  2. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988;14:9–17
  3. Hester NO. The pre-operational child's reaction to immunization. Nurs Res. 1979;28:250–254
  4. Eland JM, Anderson JE. The experience of pain in children. In:  Jaxoc A editors. Pain: a source book for nurses and other health professionals. Boston: Little, Brown; 1977;p. 453–473
  5. Lander J, Fowler-Kerry S. TENS for children's procedural pain. Pain. 1993;52:209–216
  6. Fowler-Kerry S. Adolescent oncology survivors' recollection of pain. In:  Tyler D,  Krane E editor. Advances in pain research and therapy. 15:New York: Raven; 1990;p. 365–371
  7. LeBaron S, Zeltzer L. Assessment of acute pain and anxiety in children and adolescents by self-reports, observer reports, and a behavior checklist. J Consult Clin Psychol. 1984;52:729–738
  8. McGrath PJ, Craig KD. Developmental and psychological factors in children's pain. Pediatr Clin North Am. 1989;36:823–835
  9. McGrath PJ, Unruh A. Pain research and clinical management. Amsterdam: Elsevier; 1987;
  10. Melzack R, Wall PD. The challenge of pain. Ontario: Penguin; 1988;
  11. Broome ME. The relationship between children's fears and behavior during a painful event. Children's Health Care xxxx;14:142–145.
  12. Jay SM, Ozolins M, Elliott CH, Caldwell S. Assessment of children's distress during painful procedures. Health Psychol xxxx;2:133–147.
  13. Katz ER, Kellerman J, Siegel SE. Behavioral distress in children with cancer undergoing medical procedures: developmental considerations. J Consult Clin Psychol. 1980;48:356–365
  14. Wolfer JA, Visintainer MA. Pediatric surgical patients' and parents' stress response and adjustment. Nurs Res. 1975;24:244–255
  15. Eland JM. Pharmacological management of acute and chronic pediatric pain. Issues Comprehens Pediatr Nurs. 1988;11:93–111
  16. Mather L, Mackie J. The incidence of postoperative pain in children. Pain. 1983;15:271–282
  17. Fowler-Kerry S, Lander JR. Management of injection pain in children. Pain. 1987;30:169–175
  18. Peterson L, Shigetomi C. The use of coping techniques to minimize anxiety in hospitalized children. Behav Ther. 1981;12:1–14
  19. Richter IL, McGrath PJ, Humphreys PJ, Goodman JT, Firestone P, Keene D. Cognitive and relaxation treatment of pediatric migraine. Pain. 1986;25:195–203
  20. Clarke S, Radford M. Topical anesthesia for venipuncture. Arch Dis Child. 1986;62:1132–1134
  21. Halparin DL, Koren G, Attias D, Pelligrin E, Greenberg ML, Wyss M. Topical anesthesia for venous, subcutaneous drug reservoir and lumbar punctures in children. Pediatrics. 1989;84:281–284
  22. Hopkins CS, Buckley CJ, Bush GH. Pain-free injection in infants. Anesthesia. 1988;43:198–201
  23. Hallen B, Olsson GL, Uppfeldt A. Pain-free venipuncture: effect of timing of application of local anesthetic cream. Anesthesia. 1984;39:969–972
  24. Simons DG. Myofascial trigger points: a need for understanding. Arch Phys Med Rehab. 1981;62:1132–1134
  25. Simons DG, Travell JG. Myofascial origins of low back pain. Postgrad Med. 1983;73:72–80
  26. Travell JG. Factors affecting pain of injection. JAMA. 1955;158:368–371
  27. Gebaur Pharmaceuticals prescribing information on Fluro-ethyl. Gebaur Pharmaceuticals. 1988;
  28. Eland JM. Minimizing pain associated with pre-kindergarten intramuscular injections. Issues Comprehens Pediatr Nurs. 1981;5:361–372
  29. Lander J, Fowler-Kerry S. Age differences in children's pain. Percept Motor Skills. 1991;73:415–418
  30. Wright GZ, Alpern GD. Variables influencing children's cooperative behavior at the first dental visit. J Dent Children. 1971;38:60–64
  31. Schechter NL, Bernstein BA, Beck A, Hart L, Scherzer L. Individual differences in children's response to pain: role of temperament and parental characteristics. Pediatrics. 1991;87:171–177
  32. Beecher HK. The powerful placebo. JAMA. 1955;159:1602–1606
  33. Piaget J, Inhelder B. The psychology of the child. New York: Basic; 1969;
  34. Beecher HK. Surgery as placebo. JAMA. 1961;176:1102–1107
  35. Evans FJ. The placebo response in pain reduction. In:  Bonica JJ editors. Advances in neurology. 4:New York: Raven; 1974;p. 289–296

PII: 0885-3924(95)00086-0

Journal of Pain and Symptom Management
Volume 10, Issue 8 , Pages 584-590, November 1995

Article Tools