Vol 3-2 Review Article

Non-pharmacological analgesia in children and babies beyond the neonatal age

Alfredo Chiurazzi, Andrea Francioni, Neri Demarcus, Carlo V. Bellieni*

Department of Pediatrics, University of Siena, Siena, Italy

Introduction: Pain is a major problem in clinical management of children. Pharmacological analgesia is the most commonly used analgesic treatment, but in some cases the use of non-pharmacological analgesic treatments (N-PAT) has been proposed.

Purpose: Our aims were to review the effectiveness and safety of N-PAT for pain relief in children, and to point out which are the most effective.

Material and Methods: We retrieved the clinical trials published in the years 2017-2022 in two databases: PubMed and Index Medicus, analyzing them with the PRISMA method. We used the following key-words: distraction, pain, child. Then we refined our search using in the same databases the key-words “pain” and “child”, matched with the terms that describe the N-PAT: “Virtual reality”, “Robot”, “Audiovisual distraction”, “Audio Distraction”, “Buzzy”, “Videogames”, “Parents verbal interactions”, “Distraction cards”, “Magic glove”, “Ipad”, “Picture book”, “Kaleidoscope”, “Soap bubbles” and “Hand massage”. Exclusion criteria were: reviews, case reports, papers in a language other than English, including patients other than children older than one month of age.

Results: We have screened 126 articles and 66 were excluded from the final pool. The most studied painful stimulation was needle procedures, where the most effective N-PAT was virtual reality, followed by the buzzy system. In the case of other painful procedures, few studies were available; however, in any of these painful stimulations effective analgesia was obtained with the use of virtual reality. Several studies eventually show that the combination of N-PAT with analgesic topic drugs provides more effective analgesia.

Conclusion: Some non-pharmacological treatments appear actually effective. The research in this field should be implemented to get more conclusive data, but our results are in favor of more extended use of N-PAT during potentially painful procedures.

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Vol 3-2 Review Article

Intensive Short-term Dynamic Psychotherapy for Pain

Allan A. Abbass1*, Joel M. Town1, Steve Kisely2

1Centre for Emotions and Health, Dalhousie University, Halifax, Canada

2Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia

Intensive short-term dynamic psychotherapy (ISTDP) has been studied for a broad range of somatic symptom presentations including chronic pain. Drawn from two recent meta-analyses, data using ISTDP treatment for pain conditions was extracted and meta-analyzed. Ten studies, including 6 randomized controlled trials, were examined. Short- and medium-term results were available and ISTDP yielded large and persistent treatment effects for both pain and depression within group. In the short-term follow-up, large within group effects were seen for measures of anxiety, and medium within group effects were seen on measures of interpersonal problems. When ISTDP was compared to cognitive behavioral therapy methods (CBT) in randomized controlled trials, it yielded superior effects to CBT on pain and depression measures in both short- and medium-term follow-up. There was evidence of heterogeneity which was reduced by removing 2 outlying studies, yet the results remained significant and of moderate to large effects. Two studies suggested the method was cost effective by reducing healthcare costs, medication and disability costs. Based on these findings ISTDP should be considered for chronic pain treatment guidelines. Future research directions are discussed.

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Vol 3-2 Case Report

Intranasal phenylephrine in the operating room - how many drops?

Joana A. Almeida*, Andreia F. Sá, Ana M. Remelhe, Humberto S. Machado

Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Portugal

Background: Topical vasoconstrictors are commonly used to minimize bleeding during Ear, Nose and Throat surgeries. Phenylephrine is one of the most commonly used and could be an underrecognized source of intra-operative events. Total dose of administered drugs is often unmeasured.

Cases of acute pulmonary edema, cardiac arrest and death after topical vasoconstrictors (TV) have been reported. Maintenance of cardiac output is of paramount importance to avoid cardiovascular collapse. β1 receptor blockage reduces cardiac output, it is contraindicated in these situations.

Case: This case describes an intra-operative critical event after an unknown amount of phenylephrine administration.

Conclusion: Lack of awareness about phenylephrine maximum recommended dose may induce complications leading to haemodynamic instability. The authors aim to raise awareness about the use of TV, including dose, administration site and also clinical signs and symptoms that may appear after its use.  Special attention must be addressed to the drug choice for the support treatment of eventual cardiovascular symptoms.

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