Family Practice Advance Access originally published online on October 3, 2008
Family Practice 2008 25(6):423-429; doi:10.1093/fampra/cmn069
A multifactorial strategy of pain management is associated with less pain in scheduled vaccination of children. A study realized by family practitioners in 239 children aged 4–12 years old
a Centre Hospitalier Universitaire de Nancy, Hôpital Jeanne d'Arc, F-54201 Dommartin-lès-Toul
b Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique-P 9501, F-54201 Dommartin-lès-Toul
c Université Henri Poincaré, F-54000 Nancy
d Centre Hospitalier Universitaire de Nancy, Hôpital d'enfants de Brabois Service de Pédiatrie, F-54000 Nancy, France
Correspondence to Jean-Marc Boivin, Centre d'Investigation Clinique-Institut National de la Santé et de la Recherche Médicale-Centre Hospitalier Universitaire, Hôpital Jeanne d'Arc, BP 90303, F-54201 Toul cedex, France; Email: jm.boivin{at}chu-nancy.fr
Received 9 October 2007; Revised 31 July 2008; Accepted 29 August 2008.
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Abstract |
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Background and aims. The multiplicity of vaccine injections during childhood leads to iterative painful and stressful experiences which may lead in turn to anticipated pain and then possibly to a true needle phobia. We aimed at evaluating a multifactorial strategy of pain management combining pharmacological and non-pharmacological approaches during vaccination, as compared to usual care, in 4- to 12-year-old children.
Methods. In all, 239 children were enroled by 25 family practitioners in an open-label study. After a pseudo-randomization, usual pain management (n = 132) was compared to a multifactorial strategy (n = 107) associating preliminary application of an anesthesic patch, preferential use of specified vaccines, child education by the parents and the doctor, parental accompaniment and child distraction with soap bubbles during the procedure. The primary outcome (i.e. child pain) was assessed with a self-report scale named visual analog scale (VAS) of pain.
Results. A significant decrease in pain was obtained using the multifactorial strategy, as assessed by self-reported VAS (P < 0.0001). This was confirmed by another self-report scale (the facial pain scale revised: P = 0.005), as well as with hetero-evaluations by GPs and parents [Children's Hospital of Eastern Ontario Pain Scale: P = 0.0007; GPs VAS (P < 0.0001), parents VAS (P < 0.0001)], which were secondary outcome criteria.
Conclusions. This multifactorial method significantly decreases vaccination pain in 4- to 12-year-old children. This strategy could make vaccines more acceptable to children and may improve child–doctor relationships and contribute to a decrease in child fear about health care.
Keywords. Children, family practitioner, general practitioner, pain, vaccination.
Boivin J-M, Poupon-Lemarquis L, Iraqi W, Fay R, Schmitt C and Rossignol P. A multifactorial strategy of pain management is associated with less pain in scheduled vaccination of children. A study realized by family practitioners in 239 children aged 4–12 years old. Family Practice 2008; 25: 423–429.