Skip to main content

Nonpharmacological Treatment of Neonatal Pain

  • Chapter
  • 972 Accesses

Abstract

The alleviation of pain is a basic and human right regardless of age. It therefore seems unbelievable how long it took the medical community to realize that newborns are able to feel pain. During the last 25 years, there has been a significant increase in our knowledge of pain in neonates, and broad areas of research have been addressed in the medical, nursing, psychological, neuroscientific, social, bioethical, and philosophical literature [1]. Despite these impressive gains, many of the previously identified and newer challenges remain, since we have not completely reversed the de-emphasis of infant pain [2], and no effective methods of preventing or treating pain for all infants in all clinical situations have been developed. However, the reason most of these challenges remain is because of the large gap that exists between published research results and routine clinical practice [3].

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Stevens B, Anand KJ (2000) An overview of neonatal pain. In: Anand KJ, Stevens B, McGrath P (eds) Pain in neonates. Elsevier Science B.V., Amsterdam, pp 1–7

    Google Scholar 

  2. Fitzgerald M (2000) Development of the peripheral and spinal pain system. In: Anand KJ, Stevens B, McGrath P (eds) Pain in neonates. Elsevier Science B.V., Amsterdam, pp 9–21

    Google Scholar 

  3. Carbajal R et al (2008) Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 300(1):60–70

    Article  CAS  PubMed  Google Scholar 

  4. Simons SH et al (2003) Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med 157(11):1058–1064

    Article  PubMed  Google Scholar 

  5. Barker DP, Rutter N (1995) Exposure to invasive procedures in neonatal intensive care unit admissions. Arch Dis Child Fetal Neonatal Ed 72(1):F47–F48

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Cruz MD, Fernandes AM, Oliveira CR (2016) Epidemiology of painful procedures performed in neonates: a systematic review of observational studies. Eur J Pain 20(4):489–498

    Article  CAS  PubMed  Google Scholar 

  7. Vinall J et al (2014) Invasive procedures in preterm children: brain and cognitive development at school age. Pediatrics 133(3):412–421

    Article  PubMed  PubMed Central  Google Scholar 

  8. Grunau RE et al (2009) Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants. Pain 143(1–2):138–146

    Article  PubMed  PubMed Central  Google Scholar 

  9. Anand KJ, Palmer FB, Papanicolaou AC (2013) Repetitive neonatal pain and neurocognitive abilities in ex-preterm children. Pain 154(10):1899–1901

    Article  PubMed  Google Scholar 

  10. Zwicker JG et al (2013) Score for neonatal acute physiology-II and neonatal pain predict corticospinal tract development in premature newborns. Pediatr Neurol 48(2):123–129. e1

    Article  PubMed  PubMed Central  Google Scholar 

  11. Taddio A et al (1997) Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 349(9052):599–603

    Article  CAS  PubMed  Google Scholar 

  12. Stevens B, Gibbins S, Franck LS (2000) Treatment of pain in the neonatal intensive care unit. Pediatr Clin N Am 47(3):633–650

    Article  CAS  Google Scholar 

  13. Menon G, Anand KJ, McIntosh N (1998) Practical approach to analgesia and sedation in the neonatal intensive care unit. Semin Perinatol 22(5):417–424

    Article  CAS  PubMed  Google Scholar 

  14. Harpin VA, Rutter N (1983) Making heel pricks less painful. Arch Dis Child 58(3):226–228

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. McIntosh N, van Veen L, Brameyer H (1994) Alleviation of the pain of heel prick in preterm infants. Arch Dis Child Fetal Neonatal Ed 70(3):F177–F181

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Barker D, Latty B, Rutter N (1994) Heel blood sampling in preterm infants: which technique? Arch Dis Child Fetal Neonatal Ed 71:F206–F208

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Paes B et al (1993) A comparative study of heel-stick devices for infant blood collection. Am J Dis Child 147(3):346–348

    CAS  PubMed  Google Scholar 

  18. Barker DP et al (1996) Capillary blood sampling: should the heel be warmed? Arch Dis Child Fetal Neonatal Ed 74(2):F139–F140

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Larsson BA et al (1998) Venipuncture is more effective and less painful than heel lancing for blood tests in neonates. Pediatrics 101(5):882–886

    Article  CAS  PubMed  Google Scholar 

  20. Shah VS et al (1997) Neonatal pain response to heel stick vs venepuncture for routine blood sampling. Arch Dis Child Fetal Neonatal Ed 77(2):F143–F144

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Shah VS, Ohlsson A (2011) Venepuncture versus heel lance for blood sampling in term neonates. Cochrane Database Syst Rev 10:CD001452

    Google Scholar 

  22. Blass EM, Hoffmeyer LB (1991) Sucrose as an analgesic for newborn infants. Pediatrics 87(2):215–218

    CAS  PubMed  Google Scholar 

  23. Harrison D, Beggs S, Stevens B (2012) Sucrose for procedural pain management in infants. Pediatrics 130(5):918–925

    Article  PubMed  Google Scholar 

  24. Stevens B et al (2013) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 1:CD001069

    Google Scholar 

  25. Slater R et al (2010) Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. Lancet 376(9748):1225–1232

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Johnston CC et al (1999) Effect of repeated doses of sucrose during heel stick procedure in preterm neonates. Biol Neonate 75(3):160–166

    Article  CAS  PubMed  Google Scholar 

  27. Stevens B et al (1997) The efficacy of sucrose for relieving procedural pain in neonates—a systematic review and meta-analysis. Acta Paediatr 86(8):837–842

    Article  CAS  PubMed  Google Scholar 

  28. Barr RG et al (1994) Effects of intra-oral sucrose on crying, mouthing and hand-mouth contact in newborn and six-week-old infants. Dev Med Child Neurol 36(7):608–618

    Article  CAS  PubMed  Google Scholar 

  29. Allen KD, White DD, Walburn JN (1996) Sucrose as an analgesic agent for infants during immunization injections. Arch Pediatr Adolesc Med 150(3):270–274

    Article  CAS  PubMed  Google Scholar 

  30. Barr RG et al (1995) “Sucrose analgesia” and diphtheria-tetanus-pertussis immunizations at 2 and 4 months. J Dev Behav Pediatr 16(4):220–225

    Article  CAS  PubMed  Google Scholar 

  31. Rogers AJ et al (2006) A randomized, controlled trial of sucrose analgesia in infants younger than 90 days of age who require bladder catheterization in the pediatric emergency department. Acad Emerg Med 13(6):617–622

    Article  PubMed  Google Scholar 

  32. Lewindon PJ, Harkness L, Lewindon N (1998) Randomised controlled trial of sucrose by mouth for the relief of infant crying after immunisation. Arch Dis Child 78(5):453–456

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Ramenghi LA et al (2002) Intra-oral administration of sweet-tasting substances and infants’ crying response to immunization: a randomized, placebo-controlled trial. Biol Neonate 81(3):163–169

    Article  CAS  PubMed  Google Scholar 

  34. Schechter NL et al (2007) Pain reduction during pediatric immunizations: evidence-based review and recommendations. Pediatrics 119(5):e1184–e1198

    Article  PubMed  Google Scholar 

  35. Harrison D et al (2010) Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review. Arch Dis Child 95(6):406–413

    Article  PubMed  Google Scholar 

  36. Barr RG et al (1999) The response of crying newborns to sucrose: is it a “sweetness” effect? Physiol Behav 66(3):409–417

    Article  CAS  PubMed  Google Scholar 

  37. Bueno M et al (2013) A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag 18(3):153–161

    Article  PubMed  PubMed Central  Google Scholar 

  38. American Academy of Pediatrics. Canadian Paediatric Society (2000) Prevention and management of pain and stress in the neonate. American Academy of Pediatrics. Committee on Fetus and Newborn. Committee on Drugs. Section on Anesthesiology. Section on Surgery. Canadian Paediatric Society. Fetus and Newborn Committee. Pediatrics 105(2):454–461

    Article  Google Scholar 

  39. Royal Australasian College of Physician. Paediatrics & Child Health Division (2005) Guideline statement: management of procedure-related pain in neonates. http://www.racp.edu.au [follow the links to Health Policy and Advocacy, the Paediatrics and Child Health]

  40. American Academy of Pediatrics (2016) Prevention and management of procedural pain in the neonate: an update. Pediatrics 137(2):1–13

    Google Scholar 

  41. Skogsdal Y, Eriksson M, Schollin J (1997) Analgesia in newborns given oral glucose. Acta Paediatr 86(2):217–220

    Article  CAS  PubMed  Google Scholar 

  42. Carbajal R et al (1999) Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates. BMJ 319(7222):1393–1397

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Carbajal R et al (2002) Crossover trial of analgesic efficacy of glucose and pacifier in very preterm neonates during subcutaneous injections. Pediatrics 110(2 Pt 1):389–393

    Article  PubMed  Google Scholar 

  44. Deshmukh LS, Udani RH (2002) Analgesic effect of oral glucose in preterm infants during venipuncture—a double-blind, randomized, controlled trial. J Trop Pediatr 48(3):138–141

    Article  PubMed  Google Scholar 

  45. Eriksson M, Finnstrom O (2004) Can daily repeated doses of orally administered glucose induce tolerance when given for neonatal pain relief? Acta Paediatr 93(2):246–249

    Article  PubMed  Google Scholar 

  46. Guala A et al (2001) Glucose or sucrose as an analgesic for newborns: a randomised controlled blind trial. Minerva Pediatr 53(4):271–274

    CAS  PubMed  Google Scholar 

  47. Isik U et al (2000) Comparison of oral glucose and sucrose solutions on pain response in neonates. J Pain 1(4):275–278

    Article  CAS  PubMed  Google Scholar 

  48. Kumari S, Datta V, Rehan H (2016) Comparison of the efficacy of oral 25% glucose with oral 24% sucrose for pain relief during heel lance in preterm neonates: a double blind randomized controlled trial. J Trop Pediatr 63(1):30–35

    Article  PubMed  Google Scholar 

  49. Blass EM, Watt LB (1999) Suckling- and sucrose-induced analgesia in human newborns. Pain 83(3):611–623

    Article  CAS  PubMed  Google Scholar 

  50. Stevens B, Yamada J, Ohlsson A (2004) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 3:CD001069

    Google Scholar 

  51. Gibbins S et al (2002) Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res 51(6):375–382

    Article  PubMed  Google Scholar 

  52. Taddio A et al (2008) Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures. CMAJ 179(1):37–43

    Article  PubMed  PubMed Central  Google Scholar 

  53. Stevens B et al (2005) Consistent management of repeated procedural pain with sucrose in preterm neonates: is it effective and safe for repeated use over time? Clin J Pain 21(6):543–548

    Article  PubMed  Google Scholar 

  54. Johnston CC et al (2002) Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks’ postconceptional age. Pediatrics 110(3):523–528

    Article  PubMed  Google Scholar 

  55. Blackburn S, Patteson D (1991) Effects of cycled light on activity state and cardiorespiratory function in preterm infants. J Perinat Neonatal Nurs 4(4):47–54

    Article  CAS  PubMed  Google Scholar 

  56. Mann NP et al (1986) Effect of night and day on preterm infants in a newborn nursery: randomised trial. Br Med J (Clin Res Ed) 293(6557):1265–1267

    Article  CAS  Google Scholar 

  57. Stevens B et al (1996) Developmental versus conventional care: a comparison of clinical outcomes for very low birth weight infants. Can J Nurs Res 28(4):97–113

    CAS  PubMed  Google Scholar 

  58. Pillai Riddell RR et al (2015) Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 12:CD006275

    Google Scholar 

  59. Campos RG (1989) Soothing pain-elicited distress in infants with swaddling and pacifiers. Child Dev 60(4):781–792

    Article  CAS  PubMed  Google Scholar 

  60. Fearon I et al (1997) Swaddling after heel lance: age-specific effects on behavioral recovery in preterm infants. J Dev Behav Pediatr 18(4):222–232

    Article  CAS  PubMed  Google Scholar 

  61. Grunau RE et al (2004) Does prone or supine position influence pain responses in preterm infants at 32 weeks gestational age? Clin J Pain 20(2):76–82

    Article  PubMed  PubMed Central  Google Scholar 

  62. Field T, Goldson E (1984) Pacifying effects of nonnutritive sucking on term and preterm neonates during heelstick procedures. Pediatrics 74(6):1012–1015

    CAS  PubMed  Google Scholar 

  63. Shiao SY et al (1997) Meta-analysis of the effects of nonnutritive sucking on heart rate and peripheral oxygenation: research from the past 30 years. Issues Compr Pediatr Nurs 20(1):11–24

    Article  CAS  PubMed  Google Scholar 

  64. Stevens B et al (1999) The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates. Nurs Res 48(1):35–43

    Article  CAS  PubMed  Google Scholar 

  65. Corbo MG et al (2000) Nonnutritive sucking during heelstick procedures decreases behavioral distress in the newborn infant. Biol Neonate 77(3):162–167

    Article  CAS  PubMed  Google Scholar 

  66. Bellieni CV et al (2002) Effect of multisensory stimulation on analgesia in term neonates: a randomized controlled trial. Pediatr Res 51(4):460–463

    Article  PubMed  Google Scholar 

  67. Pinelli J, Symington A, Ciliska D (2002) Nonnutritive sucking in high-risk infants: benign intervention or legitimate therapy? J Obstet Gynecol Neonatal Nurs 31(5):582–591

    Article  PubMed  Google Scholar 

  68. Bellieni CV et al (2001) Sensorial saturation: an effective analgesic tool for heel-prick in preterm infants: a prospective randomized trial. Biol Neonate 80(1):15–18

    Article  CAS  PubMed  Google Scholar 

  69. Gray L, Watt L, Blass EM (2000) Skin-to-skin contact is analgesic in healthy newborns. Pediatrics 105(1):e14

    Article  CAS  PubMed  Google Scholar 

  70. Johnston CC et al (2003) Kangaroo care is effective in diminishing pain response in preterm neonates. Arch Pediatr Adolesc Med 157(11):1084–1088

    Article  PubMed  Google Scholar 

  71. Benoit B et al (2016) Staff nurse utilization of kangaroo care as an intervention for procedural pain in preterm infants. Adv Neonatal Care 16(3):229–238

    Article  PubMed  Google Scholar 

  72. Gray L et al (2002) Breastfeeding is analgesic in healthy newborns. Pediatrics 109(4):590–593

    Article  PubMed  Google Scholar 

  73. Carbajal R et al (2003) Analgesic effect of breast feeding in term neonates: randomised controlled trial. Br Med J 326(7379):13–15

    Article  Google Scholar 

  74. Shendurnikar N, Gandhi K (2005) Analgesic effects of breastfeeding on heel lancing. Indian Pediatr 42(7):730–732

    PubMed  Google Scholar 

  75. Phillips RM, Chantry CJ, Gallagher MP (2005) Analgesic effects of breast-feeding or pacifier use with maternal holding in term infants. Ambul Pediatr 5(6):359–364

    Article  PubMed  Google Scholar 

  76. Shah PS et al (2012) Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 12:CD004950

    PubMed  Google Scholar 

  77. Bilgen H et al (2001) Comparison of sucrose, expressed breast milk, and breast-feeding on the neonatal response to heel prick. J Pain 2(5):301–305

    Article  CAS  PubMed  Google Scholar 

  78. Gradin M, Finnstrom O, Schollin J (2004) Feeding and oral glucose—additive effects on pain reduction in newborns. Early Hum Dev 77(1–2):57–65

    Article  CAS  PubMed  Google Scholar 

  79. Blass EM, Miller LW (2001) Effects of colostrum in newborn humans: dissociation between analgesic and cardiac effects. J Dev Behav Pediatr 22(6):385–390

    Article  CAS  PubMed  Google Scholar 

  80. Bucher HU et al (2000) Artificial sweetener reduces nociceptive reaction in term newborn infants. Early Hum Dev 59(1):51–60

    Article  CAS  PubMed  Google Scholar 

  81. Ors R et al (1999) Comparison of sucrose and human milk on pain response in newborns. Eur J Pediatr 158(1):63–66

    Article  CAS  PubMed  Google Scholar 

  82. Upadhyay A et al (2004) Analgesic effect of expressed breast milk in procedural pain in term neonates: a randomized, placebo-controlled, double-blind trial. Acta Paediatr 93(4):518–522

    Article  CAS  PubMed  Google Scholar 

  83. Uyan ZS et al (2005) Effect of foremilk and hindmilk on simple procedural pain in newborns. Pediatr Int 47(3):252–257

    Article  PubMed  Google Scholar 

  84. Kemper KJ, Danhauer SC (2005) Music as therapy. South Med J 98(3):282–288

    Article  PubMed  Google Scholar 

  85. Bo LK, Callaghan P (2000) Soothing pain-elicited distress in Chinese neonates. Pediatrics 105(4):E49

    Article  CAS  PubMed  Google Scholar 

  86. Butt ML, Kisilevsky BS (2000) Music modulates behaviour of premature infants following heel lance. Can J Nurs Res 31(4):17–39

    CAS  PubMed  Google Scholar 

  87. Bergomi P et al (2014) Nonpharmacological techniques to reduce pain in preterm infants who receive heel-lance procedure: a randomized controlled trial. Res Theory Nurs Pract 28(4):335–348

    Article  PubMed  Google Scholar 

  88. Cignacco E et al (2007) The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain 11(2):139–152

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. Carbajal .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Carbajal, R. (2017). Nonpharmacological Treatment of Neonatal Pain. In: Buonocore, G., Bellieni, C.V. (eds) Neonatal Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-53232-5_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-53232-5_12

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-53230-1

  • Online ISBN: 978-3-319-53232-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics