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      A Review of CAM for Procedural Pain in Infancy: Part I. Sucrose and Non-nutritive Sucking

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          Abstract

          There is increasing concern regarding the number of painful medical procedures that infants must undergo and the potential risks of alleviating infant pain with conventional pharmacologic agents. This article is Part I of a two-part series that aims to provide an overview of the literature on complementary and alternative (CAM) approaches for pain and distress related to medical procedures among infants up to six weeks of age. The focus of this article is a review of the empirical literature on sucrose with or without non-nutritive sucking (NNS) for procedural pain in infancy. Computerized databases were searched for relevant studies including prior reviews and primary trials. The most robust evidence was found for the analgesic effects of sucrose with or without NNS on minor procedural pain in healthy full-term infants. Despite some methodological weaknesses, the literature to date supports the use of sucrose, NNS and other sweetened solutions for the management of procedural pain in infancy.

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          Most cited references61

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          The FLACC: a behavioral scale for scoring postoperative pain in young children.

          To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability. Eighty-nine children aged 2 months to 7 years, (3.0 +/- 2.0 yrs.) who had undergone a variety of surgical procedures, were observed in the Post Anesthesia Care Unit (PACU). The study consisted of: 1) measuring interrater reliability; 2) testing validity by measuring changes in FLACC scores in response to administration of analgesics; and 3) comparing FLACC scores to other pain ratings. The FLACC tool was found to have high interrater reliability. Preliminary evidence of validity was provided by the significant decrease in FLACC scores related to administration of analgesics. Validity was also supported by the correlation with scores assigned by the Objective Pain Scale (OPS) and nurses' global ratings of pain. The FLACC provides a simple framework for quantifying pain behaviors in children who may not be able to verbalize the presence or severity of pain. Our preliminary data indicates the FLACC pain assessment tool is valid and reliable.
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            Pain and its effects in the human neonate and fetus.

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              Pain in the preterm neonate: behavioural and physiological indices.

              The impact of invasive procedures on preterm neonates has received little systematic attention. We examined facial activity, body movements, and physiological measures in 56 preterm and full-term newborns in response to heel lancing, along with comparison preparatory and recovery intervals. The measures were recorded in special care and full-term nurseries during routine blood sampling. Data analyses indicated that in all measurement categories reactions of greatest magnitude were to the lancing procedure. Neonates with gestational ages as short as 25-27 weeks displayed physiological responsivity to the heel lance, but only in the heart rate measure did this vary with gestational age. Bodily activity was diminished in preterm neonates in general, relative to full-term newborns. Facial activity increased with the gestational age of the infant. Specificity of the response to the heel lance was greatest on the facial activity measure. Identification of pain requires attention to gestational age in the preterm neonate.
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                Author and article information

                Journal
                Evid Based Complement Alternat Med
                ecam
                ecam
                Evidence-based Complementary and Alternative Medicine : eCAM
                Oxford University Press
                1741-427X
                1741-4288
                December 2008
                6 November 2007
                : 5
                : 4
                : 371-381
                Affiliations
                1Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA and 2John C. Liebeskind History of Pain Collection, Louise M. Darling Biomedical Library, UCLA
                Author notes
                For reprints and all correspondence: Jennie C. I. Tsao, PhD, Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10940 Wilshire Blvd., Suite 1450, Los Angeles, CA 90024, USA Tel: (310) 824-7667; Fax: (310) 824-0012; E-mail: jtsao@ 123456mednet.ucla.edu
                Article
                nem084
                10.1093/ecam/nem084
                2586318
                18955276
                89e9094d-f1dd-4cb7-a62e-4ea0dc42fe12
                © 2007 The Author(s).

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 9 February 2007
                : 24 April 2007
                Categories
                Reviews

                Complementary & Alternative medicine
                nonnutritive sucking,procedural pain,neonate,sucrose,infant
                Complementary & Alternative medicine
                nonnutritive sucking, procedural pain, neonate, sucrose, infant

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