Thursday, September 06, 2007

Pain, pain, it can go away

Pain, pain, it can go away

From Thursday's Globe and Mail

By the time they reach school age, children have received about two dozen vaccinations to protect them against once-deadly infectious diseases.

Then they can look forward to a handful more at school.

If a child falls ill, suffers traumatic injury or requires surgery, blood tests and intravenous lines will be required.

In some cases, such as leukemia, there can be marrow transplants and lumbar punctures.

Needles are an integral part of modern childhood. And despite the advent of new technologies such as nasal sprays and needle-less needles, poking and jabbing will remain de rigueur for the foreseeable future.

Needles will remain, but does the pain need to? Does that uncomfortable - and sometimes much worse - jab in the arm, leg or backside actually have to hurt, physically and psychologically?

No, it does not.

There exist today cheap, safe and effective ways of greatly reducing - but not eliminating entirely - the pain of needles.

But a new study, published this week in the journal Pediatrics and conducted by researchers at the Toronto Hospital for Sick Children, shows that pediatricians and parents are not routinely using topical anesthetics (essentially creams that numb the skin). In fact, they are barely using them at all.

The study shows that fewer than 6 per cent of pediatricians routinely use topical anesthetics. Rather, they prefer to recommend painkillers such as acetaminophen and ibuprofen after the shots.

Instead of preventing pain, there is some token effort to mitigate it afterwards.

What kind of twisted thinking is taking place here? Is a child not entitled to pain relief, especially if it is readily and cheaply available?

Anna Taddio, a pharmacist and scientist at the SickKids Research Institute thinks so.

She says the notion that the pain of needles is the price to pay for the benefit vaccines and medications provide is outdated and damaging.

"Our culture of not treating pain comes from not being able to do it," Dr. Taddio says. "But we can now treat pain from the start with topical anesthetics and other methods."

There are, of course, parents and health professionals who will balk at this kind of talk. What's the big deal with a few needle sticks when you can prevent so much suffering from childhood illnesses?

But this isn't the same thing as a scraped knee as a byproduct of playing in the park. Vaccines are premeditated and the pain is predictable and preventable.

We can have it both ways: We can protect children with vaccines and minimize their trauma.

And make no mistake: The trauma is real and it is often lasting.

Fully half of all children fear needles. And about one in 10 children fear them so much they're considered to have full-blown aichmophobia - a terror of needles that tends to develop around age 4 or 5.

Dr. Taddio argues convincingly that, in addition to the physical pain children feel when they get their vaccines, the psychological pain taints the whole health-care experience.

"Pain is the hidden cost of immunization," she says. "Needles have become a negative symbol of health care. They make children fearful of getting care, and that can influence how they feel the rest of their lives," she says.

In some cases, parents will opt out of immunization because their children fear needles.

As they grow up, the needle phobics may avoid doctors' visits and physical exams. Getting blood donors is a constant challenge, in part because of the fear of needles that begins in childhood.

So what are parents to do?

First and foremost, raise the issue with your health-care professional. There is no reason a child should not receive a local anesthetic cream or gel before an injection, and pain relief afterwards.

(But note that the research shows that drugs like acetaminophen and ibuprofen are only useful if the child has symptoms such as swelling or fever.)

Parents can also buy the products themselves at the pharmacy.

In Canada, there are three topical anesthetics sold over the counter: lidocaine-prilocaine (brand name EMLA cream), amethocaine (Ametop gel) and lidocaine cream (Maxilene). Talk to the nurse or doctor beforehand to ensure you know the injection site and apply the cream or gel liberally before bringing a child in for a vaccine.

For their part, health-care professionals, from pediatricians through to public health nurses, can and should make topical anesthetics an integral part of the armamentarium.

They can also incorporate other techniques into the immunization routine to minimize pain such as distraction (soap bubbles, video games, headsets, hypnosis) and so on.

Our kids today are pin cushions. The least we can do is minimize their pain.

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