- Meeting abstract
- Open Access
Non-pharmacological intervention for neonatal pain control
Italian Journal of Pediatrics volume 40, Article number: A52 (2014)
Acute pain and distress during medical procedures are commonplace in newborn admitted to Intensive Care Unit and can have detrimental effects, if uncontrolled.
Accumulating evidence suggests that neonate, as older children, could benefice of non pharmacological interventions (NPIs) to relive mild to moderate pain, anxiety and discomfort from minor invasive procedures.  These therapies include nonnutritive sucking (NNS) both with and without sucrose, swaddling, positioning, facilitated tucking (FT), kangaroo care or skin to skin contact (KMC), multi-sensorial stimulation (SS) and music therapy.
Material and methods
To assess efficacy of NPIs for acute procedural pain in neonate, a literature search covered the period 2000-2014 via Medline and Cochrane Library database, was undertaken. Inclusion criteria were preterm and newborn, involved in randomized controlled or crossover trial. Pain reactivity was described in term of physiological parameters (heart rate, oxygen saturation) behavioral indicators (duration of first cry and total crying time) and validated unidimensional, multidimensional and/or composite pain scores as PIPP, NIPS, DAN, NFCS etc. Two independent reviewers extracted data and methodological quality was assessed, according with GRADE system.
Nineteen Randomized Controlled Trials and twelve meta-analysis and systematic reviews were taken in consideration. The efficacy of NPIs in reliving pain and distress from skin-breaking procedures has been demonstrated mostly in heel prick and venipuncture. (Table 1)
There are sufficient evidence that supports efficacy in reducing pain-relating behaviors for NNS, swaddling and FT in preterm and term neonates.  KMC appears to be effective, as measured by composite pain score including physiological and behavioral indicators and safe for single painful procedures, alone or combined with other NPIs.  Small volumes of 24% sucrose with or without NNS reduced efficiently behavioral expressions of pain and crying time, as well as PIPP scores.  Also expressed human milk or breastfeeding, if available, should be used to alleviate procedural pain , as well as 20-30% glucose . SS is more effective than glucose and sucking, but there are no studies comparing SS and standard sucrose 24% and NNS with pacifier, which actually is the standard of care for heel lance. 
Limited evidence suggests that Music Therapy may be beneficial primarily for measures of behavior and pain, however the heterogeneity of the study preclude definitive conclusions. 
As the efficacy of the majority of NPIs is clearly demonstrated in preterm and neonates, they should be considered for inclusion in a graduated multidisciplinary algorithm for neonatal pain management.
Pillar Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ahola Kohut S, Hillgrove Stuart J, Stevens B, Gerwitz-Sten A: Non-pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews. 2011, CD006275-10
Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R: Skin-to-skin for procedural pain in neonates. Cochrane Database of Systematic Reviews. 2014, CD008435-1
Stevens B, Yamada J, Lee GY, Ohlsson A: Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews. 2013, CD001069-1
Shah PS, Herbozo C, Aliwalas LL, Shah VS: Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database of Systematic Reviews. 2013, CD004950-12
Bueno M, Yamada J, Harrison D, Khan S, Ohlsson A, Adams-Webber T, Beyene J, Stevens B: A systematic review and meta-analysis of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag. 2013, 18: 153-161.
Bellieni CV, Bagnoli F, Perrone S, Nenci A, Cordelli DM, Fusi M, Ceccarelli s, Buonocore G: Effect of multisensory stimulation on analgesia in term neonates: a randomized controlled trial. Pediatr Res. 2002, 51: 460-3. 10.1203/00006450-200204000-00010.
Harling L, Shaik MS, Tjosvold L, Leich R, Liang Y, Kumar M: Music for medical indications in the neonatal period: a systematic review of randomized controlled trials. Arch Dis Child Fetal Neonatal Ed. 2009, 94: F349-354. 10.1136/adc.2008.148411.
Rights and permissions
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
About this article
Cite this article
Lago, P., Garetti, E., Pirelli, A. et al. Non-pharmacological intervention for neonatal pain control. Ital J Pediatr 40 (Suppl 2), A52 (2014). https://doi.org/10.1186/1824-7288-40-S2-A52
- Human Milk
- Music Therapy
- Term Neonate
- Procedural Pain
- Behavioral Indicator