Sugar Relieves Pain In Kids: Study

Parents who cringe at the thought of their child suffering because of an injection, blood test or tube being inserted can take heart as research, including two new Canadian studies released Monday, sheds more light on how to alleviate the pain.
  
Doctors in the emergency room at the Children’s Hospital of Eastern Ontario in Ottawa found that a vapocoolant spray reduced pain by 34 per cent in children aged six to 12 who were having intravenous procedures, such as a tube being inserted or an injection.
  
And a study of newborns at Mount Sinai Hospital in Toronto found that those who received sugar water, or sucrose, had lower pain scores when blood was taken than babies given a placebo. However, it was a surprise that there was no significant difference in pain between the two groups when it came to vitamin K injections and the initial three heel lances done on newborns of diabetic mothers.
  
Both papers were published in the Canadian Medical Association Journal with a commentary by Dr. Kanwaljeet Anand, a pediatrician and pain expert at the University of Arkansas for Medical Sciences.
  
The studies were well-designed and the findings are important, Anand said in an interview from Little Rock, Ark.
  
“Twenty-five years ago when I tried to sort of work on this area, you know, people said: `Why are concerned with this? Babies don’t feel pain.’ And so I’m delighted to see that there is increasing data and increasing interest in this whole area of pediatric care,” he said.
  
The sucrose study, involving 240 newborns, was led by Anna Taddio, associate professor at the Leslie Dan Faculty of Pharmacy at the University of Toronto and an adjunct scientist at the Hospital for Sick Children.
  
She embarked on the research because guidelines suggest that sucrose be used to control pain in babies, but there wasn’t enough detailed scientific evidence to back them up.
  
Previous trials hadn’t mimicked the real world in which healthy newborns receive an intramuscular injection of vitamin K within an hour of birth and undergo next-day collection of blood for a newborn screening test. And infants with diabetic mothers are subjected to a lot more tests.
  
To assess pain in the newborns, researchers analyzed facial expressions and heart rate, among other things.
  
“We found that overall, sucrose did appear to work, so it was kind of consistent with what the guidelines are, but the surprise was that it didn’t work equally well for all the procedures,” Taddio explained.
  
“So it worked the best for the venipuncture (to draw blood), for the newborn screening test, but it didn’t really work that well for the vitamin K injection within an hour of birth, and it didn’t work that well for heel lances that the infants of diabetics were having.”
  
She said the findings call into question guidelines that suggest sucrose works well to ease the pain from a number of procedures in children up to about six months old.
  
“Sugar water works, but it doesn’t work as well as we thought it did … We need to investigate other analgesics or other ways to make it work better.”
  
“Our goal is to eliminate pain, not to just reduce it a little bit. And we’re not there. So sucrose is not the panacea for pain relief.”
  
It may be that a combination of sucrose and a topical anesthetic cream would be more effective, said Taddio, who plans to explore the idea in a future study.
  
Anand, for one, said heel pricks are “somewhat barbaric.”
  
“Heel lances should simply go away. They shouldn’t be done. They’re very painful. They are performed in an area of the body that has a higher sensitivity to pain — particularly in pre-term babies. The pain-modulating fibres have not grown down into the lower part of the spinal cord, and so pain sensitivity is higher in the feet than in the upper extremities.”
  
The vapocoolant study involved 80 children and was conducted to assess a new environmentally friendly product called Pain Ease, made by Gebauer Co. of Cleveland.
  
Dr. William Splinter, one of the study’s authors, said the spray temporarily numbs or freezes the skin, so it’s ideal for use in an emergency room when there’s no time for a topical cream to take effect.
  
“It works roughly in a minute, and it wears off quickly, too,” he noted.
  
Before the study, Splinter said researchers were concerned that “with the blanching and the cooling of the area, (it) would make it potentially more difficult to actually access the vein to start the intravenous. And we actually found a higher success rate among the children who had the Pain Ease applied.”
  
He said the product could be used in doctors’ offices for babies and children having routine immunizations, but he stopped short of recommending it for newborns such as those studied by Taddio, noting that there are separate issues for infants that young.
  
And, he cautioned, there is a danger of overapplying the product and killing the skin cells.
  
Dr. Allen Finley, a professor of anesthesia and psychology at Dalhousie University who wasn’t involved in either study, said vapocoolant isn’t perfect, but it’s a “good additional tool.”
  
“Among the findings that were really interesting in the study was that the nurses found it easier to do the procedure in the children who’d had the vapocoolant, so it means fewer attempts because of greater success rate,” Finley said from Halifax, where he is medical director of the pediatric pain service at IWK Health Centre.
  
“So that’s good.”