Painful Procedures Research Articles

The potential impact of chronobiology in the care of newborns in the Neonatal Intensive Care Unit

Newborns admitted to the Neonatal Intensive Care Unit (NICU) are exposed to care routines and interventions that significantly alter their biological rhythms. These interventions include exposure to irregular or continuous lighting patterns, artificial temperature maintenance, high noise levels, intermittent feeding schedules, mechanical ventilation, administration of medications, and painful or stressful procedures. The aim of this study is to reflect on the impacts resulting from the disruption of biological rhythms in newborns admitted to the NICU and to explore evidence-based strategies to disseminate chronobiological principles and foster clinical practice in this context. The variety of manipulations and environmental changes to which newborns are exposed – often chaotic and conflicting – not only compromises the development of circadian rhythms and the overall health of the newborns, but also negatively influences hospitalization duration, weight gain, and neuroendocrine development. Although the importance of circadian rhythmicity is widely recognized, the care provided to newborns in the NICU has not yet adequately incorporated these principles. In this scenario, the nursing team emerges as a central agent in implementing chronosensitive practices at the bedside to bridge this clinical gap. The need for innovative approaches is evident, with the potential to transform the NICU environment into a space that promotes healthy circadian development.

Occurrence rate and risk factors for rest and procedural pain in critically ill patients: A systematic review and meta-analysis.

Occurrence rate and risk factors for rest and procedural pain in critically ill patients: A systematic review and meta-analysis.

Comparative Analysis of Three Pain Scales for Evaluation of Procedural Pain in Neonates: A Cross-sectional Study

Introduction: Neonates frequently undergo painful procedures in the Neonatal Intensive Care Unit (NICU), necessitating reliable Pain Assessment Tools (PAT). While various pain scales exist, no single tool is universally accepted due to differences in validity and clinical applicability. Aim: To compare the validity and internal consistency of Neonatal Infant Pain Scale (NIPS), Premature Infant Pain Profile Assessment Revised (PIPP-R), Douleur Aigue Nouveau-né (DAN) scale, for assessing procedural pain in neonates before, during and after a heel prick procedure. Materials and Methods: A cross-sectional study was conducted among 60 term neonates in a rural teaching hospital. The neonates underwent a heel prick procedure and pain scores were assessed using NIPS, DAN and PIPP-R at four time points: baseline, 30 seconds, two minutes and four minutes postprocedure. Construct validity was evaluated using repeated measures Analysis of Variance (ANOVA), concurrent validity by Pearson correlation and internal consistency by Cronbach’s alpha. Coefficient of variation was analysed to assess scale precision. Results: All three pain scales demonstrated peak pain scores at 30 seconds postheel prick, with a subsequent decline over time. NIPS and DAN exhibited high concurrent validity (r=0.939 at 30s, r=0.860 at 2 minutes). Cronbach’s alpha for NIPS, DAN and PIPP-R at 30 seconds was 0.808, 0.919 and 0.805, respectively, indicating high internal consistency. The removal of physiological parameters (heart rate, SpO2 ) from PIPP-R significantly improved its internal consistency (Cronbach’s alpha increased from 0.805 to 0.917 at 30s and from 0.822 to 0.906 at 2 minutes), whereas using only physiological parameters yielded low or negative alpha values. PIPP-R had the lowest coefficient of variation, indicating the highest precision, while DAN had the highest. Conclusion: NIPS and DAN have good concurrent validity between them. PIPP-R had the least coefficient of variation and hence most precise. DAN has high internal consistency across the timelines.

The use of a virtual reality device (HypnoVR®) during extracorporeal shockwave lithotripsy for urinary stones: A case-control study.

The use of a virtual reality device (HypnoVR®) during extracorporeal shockwave lithotripsy for urinary stones: A case-control study.

Efficacy of 25% dextrose gel in reducing procedural pain in preterm infants: a prospective observational study

Background: Preterm infants in neonatal intensive care units (NICUs) undergo frequent painful procedures, increasing their risk for adverse neurodevelopmental outcomes. Non-pharmacologic interventions are sought for safe, effective pain management. We evaluated the efficacy of 25% dextrose gel (Nanodex, Analeptik Biologicals) for procedural pain relief in preterm neonates. Methods: This prospective observational study enrolled 53 preterm infants over 12 months. 25% dextrose gel (Nanodex, Analeptik Biologicals) was administered buccally at 0.5 ml/kg, 2 minutes before procedures including venepuncture, intubation, heel prick, nasogastric/orogastric tube insertions, and retinopathy of prematurity (ROP) screening. Historical data was used as control group. Pain was assessed using the premature infant pain profile (PIPP) score. Results: The mean PIPP score across all procedures was significantly lower post-25% dextrose gel (mean: 6.9±1.9) compared to historical reference scores (mean: 11.2±2.1, p<0.001). The greatest reduction was observed during ROP screening. No adverse events were recorded. Conclusions: 25% dextrose gel is a safe and effective intervention for procedural pain management in preterm infants. Its routine use in NICU protocols should be considered.

Anterolateral hip injection approach under portable ultrasound guidance: a prospective randomized controlled trial versus conventional ultrasound.

This study aimed to evaluate an innovative anterolateral approach using portable ultrasound, comparing the accuracy and safety of portable ultrasound-guided, conventional ultrasound-guided, and landmark-based blind injection techniques. In this single-centre, prospective, randomised controlled trial, 117 patients with hip pain were randomly assigned to three groups: landmark-based blind injection (n = 39), conventional ultrasound-guided injection (n = 39), and portable ultrasound-guided injection (n = 39). Each patient received a unilateral injection of 2.5ml hyaluronic acid and 1ml betamethasone via the anterolateral approach, using parameters optimized from previous research. Primary endpoints included success and accuracy rates, while secondary endpoints comprised post-injection visual analogue scale (VAS) pain scores, procedure time, puncture depth, and complications. The portable ultrasound group achieved 100% success and accuracy rates, comparable to the conventional ultrasound group, whereas the blind group showed lower success (87.2%) and accuracy (79.4%) rates. Post-injection VAS pain scores were significantly lower in the portable ultrasound group (1.95, SD 0.99) compared with the blind group (2.95, SD 1.61; p = 0.007) and similar to those in the conventional ultrasound group (2.41, SD 1.27; p = 0.337). Procedure times were comparable across all groups, and no significant differences in puncture depth were observed. Importantly, no injection-related complications were reported. Portable ultrasound-guided injections via the anterolateral approach demonstrate accuracy and safety comparable to conventional ultrasound-guided injections. Additionally, the portable device offers advantages in portability, reduced space requirements, and cost-effectiveness, thereby enhancing clinical utility in outpatient settings.

Comparison of Dexmedetomidine and Midazolam in Sedoanalgesia for Lumbar Facet Radiofrequency Ablation.

Lumbar facet radiofrequency ablation (LFRA) is a painful procedure. Sedation may be applied to improve patient comfort during the procedure however, deep sedation should be avoided to maintain the patient cooperation. The purpose of this study was to compare dexmedetomidine and midazolam in sedoanalgesia for LFRA. Patients planning to undergo LFRA were included in this cross-sectional, observational study. Following a bolus dose, intravenous infusion of dexmedetomidine was administered in Group D, while intravenous midazolam was given in Group M. Intraoperative vital signs, procedural pain severity (Numerical Rating Scale-NRS), Patient Satisfaction Score (PSS), Operator Satisfaction Score (OSS), and complications were recorded. A total of 96 patients were included in the study. Group D consisted of 47 and Group M of 49 patients. Procedural NRS, PSS, and OSS were significantly in favor of Group D. Mean procedural NRS of Group D was 2.91±2.03, and 4.14±2.17 in Group M ( P =0.005). The rate of unsatisfactory PSS was one (2.1%) in Group D and seven (20%) in Group M ( P =0.03). The rate of unsatisfactory OSS results was two (4.2%) in Group D and sixteen (32.6%) in Group M ( P <0.001). While over-sedation and low oxygen saturation were significantly more frequent in Group M, hypotension was higher in Group D. In sedoanalgesia for LFRA, dexmedetomidine is superior to midazolam with lower procedural pain, higher satisfaction scores and improved patient cooperation. The results of this study can be considered for sedoanalgesia in other interventional pain procedures.

A Single Academic Site Study of Five Years Evaluating Pharmacy Students' Palliative Care Clinical Reasoning Using Script Concordance Testing.

Introduction: This study aimed to evaluate the impact of a Pain and Palliative Care elective didactic course on enhancing clinical reasoning skills among Doctor of Pharmacy (PharmD) students using the Script Concordance Test (SCT). As palliative care education becomes increasingly vital in pharmacy training, assessing its effectiveness is essential for curriculum development. Methods: A 5-year prospective study was conducted between 2018 and 2023 at a single academic institution. The elective course was offered six times, covering various palliative care topics such as opioid management, procedural pain, and end-of-life care. A total of 130 third year PharmD candidate students, completed pre- and post-course SCT assessments. The SCT, administered via an online platform, was used to measure clinical reasoning in ambiguous scenarios, with scores compared to a panel of expert responses. Results: The study found a statistically significant improvement in SCT scores from pre- to post-course assessments (P = 0.04), with a mean score increase of 0.09. The 5-year cohort's average score (0.56) outperformed a previous multisite cohort (0.50), although the difference was not statistically significant. Item analysis highlighted areas where students struggled, such as bowel obstruction and CYP interactions, indicating potential areas for curriculum enhancement. Conclusion: This study demonstrates the effectiveness of a targeted palliative care elective in improving clinical reasoning skills among pharmacy students. The findings suggest the need for ongoing curriculum refinement to address specific areas of difficulty and ensure comprehensive palliative care education.

Transforming clinical practice in just one year: lessons from external cephalic version success.

This study aimed to assess the safety and feasibility of implementing an external cephalic version (ECV) with routinely offered regional anesthesia and its impact on the cesarean section (CS) rate at a single large center in Poland. A retrospective analysis was conducted on 110 pregnant women with non-cephalic fetal presentations who were offered an ECV procedure at term between October 2023 and November 2024. Patients were offered regional anesthesia regularly. The endpoints studied were the success rates of ECV, pain levels in the VAS (Visual Analogue Scale) score and subsequent delivery methods. A univariable regression model was employed to identify factors influencing ECV success. Of the 110 pregnant patients fulfilling the criteria for ECV, 56 underwent a total of 61 ECV attempts. Of those, 39 attempts (63.9%) were successful, resulting in 30 vaginal deliveries. Once administered, regional anesthesia significantly reduced procedural pain (VAS 3 [2-4] vs 0 [0-1] points, p < 0.001). A logistic regression model identified maternal BMI as a significant factor influencing ECV success (OR = 1.257, p = 0.018). Of the 61 attempts of ECV, two resulted in urgent cesarean section. ECV implementation resulted in a 2.12% reduction in the overall CS rate at the institution. Further reductions-up to nearly 4% - could be achieved if all eligible patients consented to the procedure. This study demonstrates that ECV, especially with regional anesthesia, is a feasible and effective strategy for reducing cesarean section rates and can be easily implemented into routine clinical practice. Widespread adoption of ECV could significantly decrease CS rates, improving perinatal care in Poland.

Virtual reality for distraction during painful procedures in pediatric surgery: A randomized clinical trial.

Virtual reality for distraction during painful procedures in pediatric surgery: A randomized clinical trial.

Effects of acoustic stimulation on painful procedures in preterm and full-term infants: A systematic review and network meta-analysis.

Effects of acoustic stimulation on painful procedures in preterm and full-term infants: A systematic review and network meta-analysis.

How frequently do hospitalized children undergo painful procedures? A longitudinal study on the number of procedures and associated factors.

How frequently do hospitalized children undergo painful procedures? A longitudinal study on the number of procedures and associated factors.

Effectiveness of social robots in improving psychological well-being of hospitalised children: A systematic review and meta-analysis.

Effectiveness of social robots in improving psychological well-being of hospitalised children: A systematic review and meta-analysis.

Predictors of vasovagal symptoms or syncope during outpatient diagnostic hysteroscopy: A prospective observational study.

Predictors of vasovagal symptoms or syncope during outpatient diagnostic hysteroscopy: A prospective observational study.

Examining the effect of virtual reality application on pain and anxiety in the care of chronic wounds on the leg.

Examining the effect of virtual reality application on pain and anxiety in the care of chronic wounds on the leg.

The impact of foot reflexology on postoperative pain and fear in children following circumcision: A randomized controlled trial.

The impact of foot reflexology on postoperative pain and fear in children following circumcision: A randomized controlled trial.

Procedural Pain and Choice of Anesthetic at Time of Polyacrylamide Hydrogel Injections for Stress Urinary Incontinence: A Randomized Controlled Trial

Procedural Pain and Choice of Anesthetic at Time of Polyacrylamide Hydrogel Injections for Stress Urinary Incontinence: A Randomized Controlled Trial

Rubber Band Ligation versus Injection Sclerotherapy for the Management of Grade I and Grade II Haemorrhoids: A Prospective Interventional Study

Introduction: Several approaches are available for treating haemorrhoids, ranging from conservative in-office procedures to more invasive surgeries. Rubber Band Ligation (RBL) and Injection Sclerotherapy (SCL) are two widely used, minimally invasive techniques that can be performed in an office setting. While both methods relieve symptoms and enhance patients’ quality of life, they vary in mechanisms, techniques, and outcomes. Despite their popularity, there is limited comparative research on their efficacy, safety, and patient satisfaction. Aim: To compare RBL and SCL regarding post-procedural pain, bleeding, relief of symptoms, and recurrence. Materials and Methods: A prospective interventional study was conducted at Sri Ramachandra Institute of Higher Education and Research, Chennai, from July 2019 to July 2021. A total of 60 patients over the age of 18 years, with grade I or II haemorrhoids, undergoing RBL or injection SCL were included. Patients were recruited by convenience sampling and allocated alternately, i.e., RBL (n=30) or SCL (n=30), and systematically compared in terms of post procedural pain, bleeding, relief of symptoms, and recurrence. Data was analysed using IBM SPSS version 23.0 statistics software. The t-tests and Chi-square tests were applied and p-value of &lt;0.05 was considered significant. Results: The mean pain score immediately post-procedure (30 minutes) was 2.6 and 1.7 in the RBL and SCL groups, respectively, p=0.024. The same trend was reported on day zero and mean pain score was significantly lower in the SCL group (0.37) as compared to the RBL group (0.93), p=0.008. In the first week, 53.3% of the RBL group presented with bleeding as compared to 20% of the SCL group, p=0.007. Patients in the RBL group reported better relief of symptoms (i.e., pain, bleeding, pruritus, sensation of mass per rectum) than patients in the SCL group, 93.3%, and 83.3%, respectively, though this data was not statistically significant. The RBL group had one recurrence (3.3%) and the SCL group had three recurrences (10%). Conclusion: The SCL group outperformed the RBL group regarding pain and bleeding in the first week post-procedure. However, clinically the pain experience was similar for both groups. While data beyond the first week was not statistically significant, SCL remains a safe and effective treatment for early haemorrhoids.

Factors Explaining Procedural Pain Management in Newborn Intensive Care Unit: A Cross- Sectional Study

Introduction: Recent research has highlighted the significant impact of procedural pain on critically ill neonates. However, effective pain management strategies to mitigate long-term negative consequences are still underutilized. Objective: To determine the effect of nurse factors on procedural pain management in neonates performed by neonatal nurses, when controlling organizational context factors and infant factors. Method: This study was cross-sectional correlation design. The participants consisted of 118 Thai NICU nurses. The Data collecting used by a self-report questionnaire. The descriptive statistics and hierarchical multiple regression analysis are used to analyze the data. Result: The findings showed that organizational supportive resources and nurse-physician collaboration had significantly positive effects on pain management in neonates (β = .349, p &lt; .001, and β = .362, p &lt; .001). Gestational age had a significant negative effect on pain management in neonates (β = -.414, p &lt; .001). Knowledge, attitude, and nurses’ experience of infant care had significant positive effects on pain management in neonates (β = .435, p &lt; .001, β = .257, p &lt; .01, and β = .236, p &lt; .01, respectively). When controlling for the organizational context factors and the infant factor, nurse factors still predicted procedural pain management in neonates. Together, the predictor variables explained 54.8% of the total variance of nurses’ pain management in neonates. It can conclude that nurse factors are important predictors of procedural pain management in neonates. Conclusion: Thus, there is a need for nurse empowerment and enhanced knowledge about neonatal pain assessment and management among NICU nurses.

Pain And Anxiety During AV Fistula Cannulation Among Hemodialysis Patients

AV fistula cannulation is a routine yet often painful and anxiety-inducing procedure for patients undergoing maintenance hemodialysis. Despite its frequency, procedural pain and psychological distress remain under-addressed, especially in low-resource settings like Pakistan. Objective: To assess the severity and prevalence of pain and anxiety during AV fistula cannulation among hemodialysis patients in a tertiary care hospital in Pakistan. Methods: This cross-sectional descriptive study was conducted at the Dialysis Unit, Department of Nephrology, Nishtar Hospital Multan, from 15 December to 15 March. A total of 135 patients undergoing maintenance hemodialysis through AV fistula were included. Pain was evaluated using the Visual Analog Scale (VAS), and anxiety was measured using the Hospital Anxiety and Depression Scale – Anxiety subscale (HADS-A). Data were analyzed using SPSS v25, with chi-square tests for statistical significance (p&lt;0.05). Results: Pain during cannulation was reported by 92.6% of patients, with 28.1% experiencing mild, 38.5% moderate, and 25.9% severe pain. Anxiety was present in 62.9% of patients (31.1% mild, 20.7% moderate, 11.1% severe). Significant associations were found between anxiety and female gender (p&lt;0.05), as well as between severe pain and longer dialysis duration (p=0.032). Conclusion: Pain and anxiety are highly prevalent during AV fistula cannulation among Pakistani hemodialysis patients. Integrating pain management and psychological screening into routine dialysis care may significantly improve the well-being of this vulnerable population.