Massage therapy as a non-pharmacological analgesia for procedural pain in neonates: A scoping review

Physical Activity to Reduce Pain Scale in Diabetic Neuropathy Patients: A Scoping Review

Purpose

This study aims to identify physical activity that can reduce pain scales in diabetic neuropathy patients.

Patients and Methods

The scoping review method was used in this research using three databases and one search engine, namely PubMed, CINAHL, Sage Journal, and Google Scholar. Inclusion criteria include full-text articles and publications in English and Indonesian between 2012-2022 with a minimal quasi-experimental design. Critical Appraisal was used to assess the article's bias.

Results

Research found 12 articles discussing the effectiveness of activity training in reducing the pain scale in diabetic neuropathy patients from the results of a scoping review of 12 studies, articles were found that used pain scales such as the Visual Analog Scale (VAS), Numeric Rating Scale (NRS), Foot Health Status Questionnaire Pain Score (FHSQ), and Leeds Assessment of Neuropathic symptoms and signs Scale for pain assessment, in measuring pain intensity. Some variations of physical activity include aerobic exercise, resistance exercise, vibration, and a combination of aerobic and resistance training. 30 minutes each session for 8 weeks with a frequency of 6 days/week. These studies used various designs, namely RCT, Experiment, and Quasi-experimental Pre test-post test with control group design Physical activity improves blood circulation and minimizes peripheral nerve damage so that pain intensity can decrease.

Conclusion

Conclusion: Physical activity intervention is effective in reducing pain scales in diabetic neuropathy patients and can be a supportive therapy for diabetic neuropathy patients who experience pain.

A follow up study on the effects of massage on preterm infants: A randomized controlled research

BACKGROUND

Preterm infants who leave the intrauterine environment early are deprived of tactile stimuli. This affects the physical, emotional and social developments of infants and their physical growth parameters such as weight, height and head circumference negatively.

AIM

This research was conducted to determine the effects of massage on the development of preterm infants.

MATERIAL-METHOD

This research was conducted as randomized controlled research with two groups (massage-control). The infants in the intervention group received massage for 30 days. Height, weight and head circumference values of the infants were recorded on days 5, 10, 20 and 30. Amount of feeding was recorded before intervention, on day 15 after intervention and on day 30 after intervention. Discharge times of the infants were recorded according to groups.

RESULTS

A significant difference was found in height and weight of the preterm infants on days 20 and 30 when compared with the control group. Discharge time of the infants in the massage group was found to be 10 days shorter on average when compared with the control group. Significant difference was also found between day 15 and 30 in terms of amount of feeding.

CONCLUSION

Massage was found to have significant effects on physical growth parameters such as height, weight and head circumference. It was found that massage increased amount of feeding and weight intake in infants and decreased discharge time. In this case, hospital cost per infant may be reduced.

Effect of parental touch on relieving acute procedural pain in neonates and parental anxiety (Petal): a multicentre, randomised controlled trial in the UK

BACKGROUND

Touch interventions such as massage and skin-to-skin contact relieve neonatal pain. The Parental touch trial (Petal) aimed to assess whether parental stroking of their baby before a clinically required heel lance, at a speed of approximately 3 cm/s to optimally activate C-tactile nerve fibres, provides effective pain relief.

METHODS

Petal is a multicentre, randomised, parallel-group interventional superiority trial conducted in the John Radcliffe Hospital (Oxford University Hospitals NHS Foundation Trust, Oxford, UK) and the Royal Devon and Exeter Hospital (Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK). Neonates without neurological abnormalities who were born at 35 weeks gestational age or more and required a blood test via a heel lance in the first week of life were randomly assigned (1:1) to receive parental touch for 10 s either before (intervention group) or after (control group) the clinically required heel lance. Randomisation was managed at the Oxford site using a web-based minimisation algorithm with allocation concealment. The primary outcome measure was the magnitude of noxious-evoked brain activity in response to the heel lance measured with electroencephalography (EEG). Secondary outcome measures were Premature Infant Pain Profile-Revised (PIPP-R) score, development of tachycardia, and parental anxiety score. For all outcomes, the per-protocol effect was estimated via complier average causal effect analysis on the full analysis set. The trial is registered on ISRCTN (ISRCTN14135962) and ClinicalTrials.gov (NCT04901611).

FINDINGS

Between Sept 1, 2021, and Feb 7, 2023, 159 parents were approached to participate in the study, and 112 neonates were included. 56 neonates were randomly assigned to the intervention group of parental stroking before the heel lance and 56 to the control group of parental stroking after the heel lance. The mean of the magnitude of the heel lance-evoked brain activity was 0·85 arbitrary units (a.u.; SD 0·70; n=39; a scaled magnitude of 1 a.u. represents the expected mean response to a heel lance in term-aged neonates) in the intervention group and 0·91 a.u. (SD 0·76; n=43) in the control group. Therefore, the primary outcome did not differ significantly between groups, with a mean difference of -0·11 a.u. (lower in intervention group; SD 0·77; 95% CI -0·42 to 0·20; p=0·38; n=82). No significant difference was observed across secondary outcomes. The PIPP-R difference in means was 1·10 (higher in intervention group, 95% CI -0·42 to 2·61; p=0·15; n=100); the odds ratio of becoming tachycardic was 2·08 (95% CI 0·46 to 9·46; p=0·34, n=105) in the intervention group with reference to the control group; and the difference in parental State-Trait Anxiety Inventory-State score was -0·44 (higher in control group; SD 6·85; 95% CI -2·91 to 2·02; p=0·72; n=106). One serious adverse event (desaturation) occurred in a neonate randomly assigned to the control group, which was not considered to be related to the study.

INTERPRETATION

Parental stroking delivered at an optimal speed to activate C-tactile fibres for a duration of 10 s before the painful procedure did not significantly change neonates' magnitude of pain-related brain activity, PIPP-R score, or development of tachycardia. The trial highlighted the challenge of translating an experimental researcher-led tactile intervention into a parent-led approach, and the value of involving parents in their baby's pain management.

FUNDING

Wellcome Trust and Bliss.

Effect of whole body massage on pain scores of neonates during venous puncture and comparison with oral dextrose and Kangaroo care, a randomized controlled evaluator-blind clinical study

OBJECTIVE

Newborns in NICUs experience many painful procedures. The aim of the study was to evaluate the effect of whole body massage therapy on pain scores during venipuncture and to compare with oral 10% dextrose and Kangaroo care.

STUDY DESIGN

Newborns with gestational age ≥34 weeks were randomly enrolled to one of three groups: dextrose, massage and Kangaroo care and a blinded investigator scored the pain using NIPS before and during the procedure.

RESULTS

There were 25, 26 and 23 newborns in dextrose, massage and Kangaroo care groups, respectively. Pain scores were similar before and during venipuncture in groups (p > 0.05). 36.5% of newborns (27/74) had severe pain scores. Number of newborns with no pain (score 0-2), moderate pain (score 3-4) and severe pain (score 5-7) were similar in each group.

CONCLUSION

Massage, Kangaroo and oral 10% dextrose had similar effects on pain scores during venipuncture.

Lessons learned from child health care nurses' experiences of teaching infant massage groups: A qualitative interview-based study

AIM

To describe child health care nurses' experiences of teaching infant massage in parent groups.

DESIGN

This was an exploratory-descriptive qualitative study based on individual interviews.

METHOD

Qualitative semi-structured interviews were conducted with child health care nurses (N = 9) according to the COREQ guidelines and analyzed with qualitative content analysis.

RESULTS

Five categories were identified: (1) Infant massage can promote attachment between parents/guardians and their children; (2) Infant massage can have a calming impact; (3) Stress and lack of time can be challenging; (4) The composition of parent groups can be important and (5) The child health care nurse can observe parents'/guardians' relationships with their children. Child health care nurses are uniquely familiar with infant massage and the benefits it provides both parents/guardians and their infants. Specifically, infant massage has a calming effect that reduces stress and strengthens the relationship between infants and their parents/guardians.

PATIENT OR PUBLIC CONTRIBUTION

Child health care nurses were interviewed.

A self-administered moxibustion-cum-massage intervention for older adults with chronic pain in the community: A randomized controlled trial

OBJECTIVES

To determine the effectiveness of a simple, self-administrable moxibustion-cum-massage intervention for relieving chronic pain and improving psychological well-being for older adults in the community.

DESIGN

A randomized controlled trial.

SETTING

Seventy-eight participants with chronic pain were randomly assigned to the intervention and waitlist control groups.

INTERVENTIONS

Participants received two moxa sticks a day to use the moxibustion-cum-massage procedure with the help of trained volunteers or caregivers for five consecutive days.

MAIN OUTCOME MEASURES

Participates' pain level, sleep quality, depression and subjective well-being were measured before the intervention (T0), immediately after the intervention (T1), and one week after the intervention (T2).

RESULTS

Repeated measures ANOVA revealed a significant group × time interaction effect in subjective well-being with a medium effect size. Regarding within-group effects in the intervention group at post-intervention (T1), the subjective pain level was significantly reduced with a small effect size, while sleep quality and depression significantly improved with large effect sizes. The control group showed no significant within-group effects in these variables. Maintenance effects at follow-up (T2) were not significant.

CONCLUSION

Despite the short intervention timeframe of five days, the study revealed preliminary evidence that the moxibustion-cum-massage intervention can be an effective, self-administrable pain relief regime for older adults. A longer period of intervention time is suggested for future studies.

The effect of Helfer skin tap technique on hepatitis B vaccine intramuscular injection pain in neonates: A randomized controlled trial

CONTEXT

The aim of neonatal pain management is to reduce pain and help the baby cope with pain.

OBJECTIVE

This study aimed to determine the effect of Helfer skin tap technique (HSTT) on hepatitis B vaccine intramuscular (IM) injection pain in neonetes.

DESIGN

Randomized controlled study SETTING: This study was conducted with neonatal infants born vaginally in the delivery room of a state hospital in Turkey.

PARTICIPANTS

This study was conducted total 60 neonates including 30 in the HSTT group and 30 in the Routine Technique (RT) group.

INTERVENTIONS

Participants were randomized into the HSTT group and the Routine Technique (RT) group.

MAIN OUTCOME MEASURES

Data were collected using a questionnaire form and the Neonatal Infant Pain Scale (NIPS).

RESULTS

While the means of the total pain scores in the HSTT group were found to be 1.73 ± 2.04 during injection and 1.73 ± 0.98 after injection, in the RT group, the mean scores were 5.56 ± 0.92 during injection and 4.90 ± 1.25 after injection. The difference between the groups arising in the comparison of means of the total pain scores obtained during and after injection in HSTT and RT groups was determined to be statistically significant (p <0.05).

CONCLUSION

In conclusion, HSTT was proven to be effective in reducing hepatitis B vaccine intramuscular (IM) injection pain in neonates. This study demonstrates that HSTT is associated with reduced pain in newborns during hepatitis B vaccine IM injections.

Manual and alternative therapies as non-pharmacological interventions for pain and stress control in newborns: a systematic review

BACKGROUND

Supporting therapies that provide stress and pain control of preterm and term newborns infants contribute positively to the neuropsychomotor development. Non-pharmacological interventions that involve manual techniques are described, considering protocols that can be reproduced by physical therapists, with positive and negative outcomes reports.

DATA SOURCES

Systematic review follows PRISMA 2020 statements guidelines. Primary and specific health sciences databases (Science Direct, Pubmed, Scielo, Embase and Scopus) were consulted between October 2021 and May 2022. Articles considered were clinical trials, randomized or not, that included descriptions of the type of intervention as non-pharmacological and that studied the following outcomes: "pain" and "stress".

RESULTS

Fifteen articles were selected for analysis, reaching a methodological quality of at least 3 on the Jadad Scale for the Quality of Researched Sources. The non-pharmacological therapies most applied in isolation were massage, swaddling or wrapping, gentle touch and kinesthetic stimulation, and the combined therapies were non-nutritive sucking and swaddling, oral sucrose and swaddling, sensory stimulation and familiar odors, and sensory saturation. The outcomes found were relaxation, pain, and stress reduction after the application of painful procedures. The behavioral changes included crying, grimacing, yawning, sneezing, jerky arm or leg movements, startles, and finger flaring. The vital signs included heart rate, blood oxygen saturation level, and pulse respiration.

CONCLUSIONS

Combined techniques lead to better results in controlling neonatal pain when compared to isolated techniques. They can be applied both in preterm and term infants in a safe way and are reproducible in any health unit in a simple and economical way.

The Effect of Using Endorphin Massage for Decreasing Pain at First Stage in Normal Labor

Labor pain is a subjective experience of physical sensations associated with uterine contractions, dilation, thinning cervix and fetal descent during labor. To resolve the pain of labor, it has been implemented in a nonpharmacological method which is endorphin massage, in understanding endorphin massage for pressing pain in the first stage, in an active phase of normal multiparous mothers' deliveries. This research aims to research endorphin massage's influence on suppressing pain during the active phase of normal labor of multiparous mothers. This study is quasi-experimental with a cross-sectional approach. The study population of all women giving birth administered the purposive sampling data capture techniques, and it was obtained 132 multiparous mothers with normal labor in the observation sheet. Data were examined by administering a T-test. The majority of the pain intensity in the first stage of active phase multiparous mothers with normal labor, before the breath relaxation, is severe, with up to 49% experiencing severe pain. The majority of the percentage of moderate pain in the first stage of active phase multiparous mothers with normal labor, after breath relaxation, is as high as 42%. Meanwhile, the pain intensity of the first stage in active phase multiparous mothers with normal labor, prior to endorphin massage, is as high as 73.3%. Pain intensity of the first stage in active phase multiparous mothers normal labor after endorphin massage, the majority of the percentage is moderate pain up to 53.3%. Statistical test results obtained p-value is 0.004 endorphin massage. In conclusion, there is an effect of breath relaxation on the intensity of pain during normal labor in multiparous mothers. Furthermore, researchers can do a combination of endorpine massage with other treatments to treat pain during the I active phase of labor and pain intensity checks can be done by testing cortisol levels.

Multicentre, randomised controlled trial to investigate the effects of parental touch on relieving acute procedural pain in neonates (Petal)

INTRODUCTION

Newborn infants routinely undergo minor painful procedures as part of postnatal care, with infants born sick or premature requiring a greater number of procedures. As pain in early life can have long-term neurodevelopmental consequences and lead to parental anxiety and future avoidance of interventions, effective pain management is essential. Non-pharmacological comfort measures such as breastfeeding, swaddling and sweet solutions are inconsistently implemented and are not always practical or effective in reducing the transmission of noxious input to the brain. Stroking of the skin can activate C-tactile fibres and reduce pain, and therefore could provide a simple and safe parent-led intervention for the management of pain. The trial aim is to determine whether parental touch prior to a painful clinical procedure provides effective pain relief in neonates.

METHODS AND ANALYSIS

This is a multicentre randomised controlled trial. A total of 112 neonates born at 35 weeks' gestation or more requiring a blood test in the first week of life will be recruited and randomised to receive parental stroking either preprocedure or postprocedure. We will record brain activity (EEG), cardiac and respiratory dynamics, oxygen saturation and facial expression to provide proxy pain outcome measures. The primary outcome will be the reduction of noxious-evoked brain activity in response to a heel lance. Secondary outcomes will be a reduction in clinical pain scores (Premature Infant Pain Profile-Revised), postprocedural tachycardia and parental anxiety.

ETHICS AND DISSEMINATION

The study has been approved by the London-South East Research Ethics Committee (ref: 21/LO/0523). The results will be widely disseminated through peer-reviewed publications, international conferences and via our partner neonatal charities Bliss and Supporting the Sick Newborn And their Parents (SSNAP). If the parental tactile intervention is effective, recommendations will be submitted via the National Health Service clinical guideline adoption process.

STUDY STATUS

Commenced September 2021.

TRIAL REGISTRATION NUMBER

NCT04901611; 14 135 962.

The effect of gentle human touch on pain, comfort and physiological parameters in preterm infants during heel lancing

OBJECTIVE

This research was conducted to evaluate the effects of gentle human touch (GHT) on pain, comfort, and physiologic parameters in preterm infants during heel lancing.

METHOD

This prospective, assessor-blind, randomized controlled study was performed between August 10, 2021 and September 10, 2021 in the Neonatal Intensive Care Units (NICU) of a tertiary hospital in the Central Anatolia Region of Turkey. Fifty preterm infants were randomly appointed to GHT and control groups. The researcher applied GHT to the infants in the GHT group by placing one hand on the infant's head and the other hand on the lower abdomen covering the waist and hips for 15 min. Data were collected with a Questionnaire, Physiological Parameters Observation Form, Newborn Infant Pain Scale (NIPS), The Comfort Scale (COMFORT), and Pulse Oximeter.

RESULTS

The NIPS and COMFORT mean scores of preterm infants in the GHT group were lower during (p < 0.001, p < 0.05, respectively) and after heel lancing (p < 0.05, p < 0.001, respectively). There was no difference between the preterm infants' peak heart rate, respiratory rate, and SPO₂ values in the GHT and control groups during and after heel lancing (p > 0.05). The study found that preterm infants in the GHT group had less crying time during the heel lancing (p < 0.001).

CONCLUSION

It could recommend using in painful procedures because GHT may positively affect preterm infants' pain, comfort, and physiologic parameters. The results of this study will contribute to NICU nurses should include non-pharmacological methods such as GHT to decrease pain of preterm infants in procedural pain.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05001191).

Effects of Infant Massage: A Systematic Review

Infant massage is performed in various international contexts. There is a need for an updated literature review on this topic. The purpose of the current review was to investigate the effects of infant massage. A systematic literature review was conducted to investigate the effects of infant massage on the following outcomes: pain relief, jaundice, and weight gain. The inclusion criteria were infants from 0-12 months. The literature search was performed until January 2022, using the CINAHL, PubMed, and PsycINFO databases, and included studies published from 2017-2021, returning 16 RCT/CCT studies with a total of 1416 participating infants. A review template was used by two independent reviewers to assess the risk of bias in the included studies. The results were synthesized and presented in the form of tables and narratives. In five of seven studies (n = 422 resp. n = 717) investigating pain relief, infant massage was found to alleviate pain. In all six studies (n = 455) investigating effects on infant massage and jaundice, beneficial effects were found on bilirubin levels. In all four studies (n = 244) investigating weight gain, increased weight gain was found among participants who received infant massage. The present literature review provides an indication of the current state of knowledge about infant massage and identifies its positive effects; however, the results must be interpreted with caution. Infant massage may be effective at relieving pain, improving jaundice, and increasing weight gain. Although statistically significant differences were not found between all experimental and control groups, no adverse effects of infant massage were observed. By placing the aforementioned effects in the context of child health care, infant massage may prove beneficial on these outcomes. Given the dearth of research on infant massage in the context of child health care, further research is warranted.