Modified Behavioral Pain Scale Research Articles

1460 Pain Relief Effect of Mothers‚ Hug on Infants‚ Vaccination Pain in West of Tehran, 2009

Pain management of neonate is important.Aim: To Comprise pain relieving effect of mothers' hug with routine procedure of health centers during Infants' Vaccination.Material and Method: This controlled trial study, was performed on 76 healthy term infants with 2- 4 months years old, which was brought to the health centers of Iran University of Medical Sciences in west of Tehran by their parents and had DPT Vaccination. Volunteer parents filled in informed consent of research. By randomized collection 35 infants were given in their mothers' hug, during 2 minutes before vaccination till 15 seconds after it. Second group according to routine of clinics lied on the examining bed during Vaccination. Changes in appearance of Neonates were assessed by Modified Behavioral Pain Scale (MBPS) during 5 second before immunization till 15 second after it.Descriptive and inferential statistics were used. Median scores of 2 groups were compared with the Independent sample T test. Pre and post-scores of each group were compared with the Paired sample T test.Result: 15 second after vaccination average of pain was 8.36 in control group and 6.68 in experimental group. There were significant differences in Behavioral Pain Scores of two groups in all parts of tools. (P < 0.0001) There was no significant difference between the groups regarding gender.Conclusions: Regarding to significant difference in behavioral of pain responds in two groups, it is suggested that, with simple and safe intervention of hugging infants by their mothers reduce pain during vaccination and muscular injections too.

Decoupling between fundamental frequency and energy envelope of neonate cries

Background The presence of decoupling, i.e. the absence of coupling between fundamental frequency variation and energy envelope during phonetic crying, and its extent, reflects the degree of maturation of the central nervous system. Aim We hereby wanted to assess the existence and extent of decoupling in term neonates (neurodevelopmental relevance) and whether an association between decoupling and clinical pain expression could be unveiled (clinical relevance). Study design To assess decoupling in healthy term neonates during procedural pain, newborns were videotaped and crying was recorded during venous blood sampling. Besides acoustic analysis, pain expression was quantified based on the Modified Behavioral Pain Scale (MBPS). Subjects 47 healthy term neonates underwent venous blood puncture at the 3rd day of life. Outcome measures Beside the MBPS score, the correlation coefficients were calculated between the fundamental frequency variation and energy envelope of the cries. Results Based on data collected in 47 healthy term neonates, correlation coefficients varied between 0.20 and 0.68. The degree of decoupling displayed extensive variability between the neonates and also in different cry bouts in a crying sequence within an individual neonate. A negative association was found between MBPS value and decoupling ( r 2 = − 0.12), the same as for the intra-subject variability although less extensive ( r 2 = − 0.02). Conclusion Decoupling only relates weakly with the amount of distress in 3 day old newborns, even though a great intra-subject variability is present. This study suggests that there is no evidence of extensive decoupling as the newborn still has to fully develop the control of larynx and abdominal muscles.

Assessment of Pain Expression in Infant Cry Signals Using Empirical Mode Decomposition

The presence of decoupling, i.e. the absence of coupling between fundamental frequency variation and intensity contour during phonetic crying, and its extent, reflects the degree of maturation of the central nervous system. The aim of this work was to evaluate whether Empirical Mode Decomposition (EMD) is a suitable technique for analyzing infant cries. We hereby wanted to assess the existence and extent of decoupling in term neonates and whether an association between decoupling (derived from EMD) and clinical pain expression could be unveiled. To assess decoupling in healthy term neonates during procedural pain, 24 newborns were videotaped and crying was recorded during venous blood sampling. Besides acoustic analysis, pain expression was quantified based on the Modified Behavioral Pain Scale (MBPS). Fundamental frequency and the intensity contour of the cry signals were extracted by applying the EMD to the data, and the correlation between the two was studied. Based on data collected in healthy term neonates, correlation coefficients varied between 0.39 and 0.83. The degree of decoupling displayed extended variability between the neonates and also in different cry bouts in a crying sequence within an individual neonate. When considering the individual ratio between the mean correlation of cry bouts during a crying sequence and their standard deviation, there seems to be a positive trend with increasing MBPS value. This might indicate that higher stressed subjects have less consistency in the investigated acoustic cry features, concluding that EMD has potential in the assessment of infant cry analysis.

Order of Vaccine Injection and Infant Pain Response

To determine if acute pain response after administration of the diphtheria, polio, and tetanus toxoids and acellular pertussis and Haemophilus influenzae type b (DPTaP-Hib) vaccine and the pneumococcal conjugate vaccine (PCV) is affected by the order in which they are given. Single-center, double-blind, randomized clinical trial. Outpatient pediatric clinic in Toronto, Ontario, Canada. Healthy infants 2 to 6 months of age undergoing routine immunization. Infants received either their primary DPTaP-Hib vaccine or the PCV first, followed by the other vaccine. The primary outcome was infant pain during vaccine injection as assessed by a validated measure, the Modified Behavioral Pain Scale (MBPS), using videotaped recordings of the procedure. In addition, parents rated pain using a 10-cm visual analog scale (VAS). Crying (yes/no) was also measured. The study was conducted between July 21, 2006, and June 21, 2007. A total of 120 infants participated: 60 received the DPTaP-Hib vaccine first and 60 received the PCV first. Infant characteristics did not differ between groups. Overall mean (SD) pain scores per infant after receiving both vaccine injections were significantly lower when DPTaP-Hib was administered first compared with when PCV was administered first (MBPS score, 7.6 [1.5] vs 8.2 [1.5], P = .037; parent VAS score, 4.2 [2.3] vs 5.6 [2.6], P = .003). When given first, the DPTaP-Hib vaccine caused significantly less pain (P < .001) than the PCV, as assessed by the MBPS, VAS, and crying. Pain was reduced when the DPTaP-Hib vaccine was administered before the PCV in infants undergoing routine vaccination. We recommend that the order of vaccine injections be the DPTaP-Hib vaccine followed by the PCV.

Variability in pain expression characteristics in former preterm infants

To document pain expression characteristics in former preterm infants in the first year of life in whom systematic evaluation and treatment of pain was provided. Data on the Modified Behavioral Pain Scale (MBPS), Visual Analogue Scale (VAS, crying time and heart rate were collected during immunization. The effect of clinical characteristics {postconception and gestational age [PCA], surgery, ventilation, fentanyl, length of stay (LOS)} on bio-behavioral parameters was evaluated. 121 procedures were recorded in 49 infants. GA was 28 (25-32) weeks. PCA was 60 (34-90) weeks. Median MBPS was 8 (2-10), median crying time 44 (0-112) s. Median pre-procedural heart rate was 144 (103-201) and increased to 184 (147-220) afterwards, resulting in a relative increase of 29 (5-99)%. Median VAS score was 7 (1-10). Significant correlations of PCA with pre-procedural heart rate (r=-0.36) and with relative increase in heart rate (r=0.33) were identified. A correlation of LOS on crying time (r=0.37) was observed. Correlations of PCA with pre-procedural and relative increase in heart rate reflect the maturational decrease in heart rate. LOS had an effect on pain expression, potentially reflecting the impact of cumulative 'minor' procedural pain.

Relief of MMR vaccination pain using topical 4% amethocaine

Routine vaccinations are the most common source of iatrogenic pain in infants and children, however this pain is not routinely managed. 4% amethocaine gel is a new anaesthetic agent that achieves anaesthesia within 30-45 minutes of application; this shortened application time may make its use feasible in busy clinical settings. The objective of this study was to determine the efficacy and safety of 4% amethocaine for reducing the pain of measles-mumps-rubella (MMR) vaccination. A randomized, double-blind, placebo-controlled design was employed. Healthy 1 year old infants receiving their routine 12-month MMR vaccination were recruited and randomized to receive 1g of amethocaine or a visually identical placebo for 30 minutes prior to vaccination. The vaccination procedure was videotaped and the tape used later for pain assessment. The Modified Behavioural Pain Scale (MBPS) was the primary outcome measure for pain. A 5–mL sample of blood was collected from infants 1 month post-vaccination to assess antibody titers using enzyme immunoassay. The amethocaine group (n = 61) had significantly lower pain scores than the placebo group (n = 59); 1.51 vs. 2.29 (p=0.029). There was no difference in antibody response between the amethocaine and placebo treatment groups(p<0.05). Amethocaine reduced the pain of MMR vaccination without compromisng the immunogenicity of the vaccine. Clinical Pharmacology & Therapeutics (2004) 75, P75–P75; doi: 10.1016/j.clpt.2003.11.285

EMLA ® cream and oral glucose for immunization pain in 3-month-old infants

The objective of this study is to determine whether use of lidocaine–prilocaine 5% cream (EMLA ®) and oral glucose decreases pain associated with diphteria–pertussis–tetanus (DPT) immunization in 3-month-old infants. Design: randomized, double-blind, controlled trial in outpatient paediatric practice in northern Sweden. EMLA or placebo was applied to the infant’s lateral region of the right thigh and covered with an occlusive dressing 1 h before the immunization. In addition, 1 ml of glucose (300 mg/ml) or placebo (water) was instilled on the baby’s tongue within 2 min before the DPT-injection. Forty-five infants received EMLA and glucose and 45 infants placebo cream and water. ECG was recorded and stored in a computer and the procedure was videotaped. The parents and the nurse assessed the infants' pain on a visual analogue scale (VAS) after the immunization. Heart rate and heart rate variability pre- and post-injection were calculated. From the videotapes, the modified behavioural pain scale (MBPS) was used to assess pain scores during baseline and after immunization. The latency of the first cry and total crying time were measured. The parents and the nurse scored the infants' pain on the VAS significantly lower in the treatment group than in the placebo group. The infants' responses to the immunization measured as the difference in MBPS scores pre- and post-injection were significantly lower in the EMLA–glucose group compared with the placebo group. More infants cried after the immunization in the placebo group compared with the EMLA–glucose group and the latency of the first cry after the injection was shorter in the placebo group. A biphasic transient heart rate response with a marked deceleration followed by a subsequent acceleration was seen more frequently in the placebo group compared to the EMLA–glucose group. EMLA and glucose alleviate immunization pain in 3-month-old infants.

Use of lidocaine-prilocaine cream for vaccination pain in infants

To determine whether use of lidocaine-prilocaine 5% cream (EMLA) decreases pain associated with diphtheria-pertussis-tetanus (DPT) vaccination in infants. Randomize, double-blind, controlled trial in outpatient pediatric practice, Toronto, Ontario, Canada. Before vaccination, parents applied 2.5 gm of EMLA or placebo to the infant's leg and covered it with an occlusive dressing for at least 60 minutes. The infant received a 0.5 ml intramuscular injection of DPT at 2 degree to 8 degree C with a 1.6 cm 25-gauge needle; the infant was videotaped. The Modified Behavioral Pain Scale (MBPS) was used to assess baseline and postvaccination pain scores. Latency and duration of infant cry were also measured. A total of 49 evaluable infants received EMLA, and 47 infants received placebo. There were no significant differences in demographic data; mean age was 5 months; and 50% of the subjects were male. The median difference in pre-vaccination and postvaccination MBPS scores was lower for EMLA than for placebo (p = 0.001). The latency to the first cry was longer for subjects who were treated with EMLA (p = 0.0004)), but the total crying time was shorter (10.3 seconds vs 25.2 seconds; p = 0.027). Of the study group, 90% (45/50) of subjects treated with EMLA and 12% (6/49) of subjects treated with placebo had local skin reactions (p < 0.0001), mainly skin blanching. Pretreatment with EMLA decreases infant pain from DPT vaccinations. Application of these data is limited to healthy infants receiving DPT vaccinations.

The Effect of the Local Anesthetic Cream in Alleviating Pain form Vaccination

To evaluate the effect of a new topical anesthetic cream (EMLA: Eutectic mixture of local anesthetics) on reducing pain associated with DPT vaccination, we conducted a clinical observation on eighty infants who were brought to well baby clinic of Yeungnam University Hospital for DPT vaccination. 80 Infants, who were between 2 months and 8 months in age, were divided into two groups. EMLA treated group and control group. Male to femle sex ratio was 1.4 to 1. EMLA cream was applied 60 minutes before DPT vaccination, the effect of reducing pain was assessed by using McGrath's face scale, Oucher pain scale and modified behavioral pain scale (MBPS) and also evaluated by measuring the duration and time of crying (the time of the first crying after injection, duration of the first crying, total duration of crying). The scores of those scales were lower in EMLA treated group than in control group significantly (P(0.01 in McGrath's face scale, MBPS and p sec, control group sec, p