At Children's Minnesota hospitals, a shot at reducing needle pain

For every child who has squirmed and cried over a shot or a blood draw — and every parent who has stood by helplessly — doctors at Children's Minnesota hospitals are reporting success in a campaign to eliminate needle pain.

Strategies such as numbing cream, soothing blankets and visual distractions were rolled out in 2013 on the inpatient floors of Children's hospitals in Minneapolis and St. Paul. They proved so effective that doctors extended them to the emergency room and, most recently, to all outpatient clinics.

"Bubbles work great" as distractions, said Dr. Stefan J. Friedrichsdorf, Children's director of palliative care and pain medicine.

Two studies published this month vindicate their hopes. In one study, the number of children who identified needle pokes as the cause of their worst pain during hospitalizations declined from 41 percent to 30 percent after the program launched. In another, researchers proved that the addition of the pain-reducing strategies didn't delay or slow down patient care — a major concern for doctors or nurses who resisted the idea.

Fear of needles is important, Friedrichsdorf said, because it can prevent people from seeking necessary medical treatment and important immunizations.

"There is a significant amount of people, including my own mother, who decided not to vaccinate their own children because they cannot watch their child being in pain," he said.

Children's was the first hospital in the nation to create such a systemwide program, but Friedrichsdorf said the new studies will persuade other hospitals to copy the approach.

Friedrichsdorf's interest in reducing needle pain came partly through his childhood. He got the measles and transmitted it to friends during his 10th birthday party. He also recalls getting a shot while being held down by two physicians, which created more alarm.

"It's absolutely incorrect to hold children down," he said. "It's never effective."

Stacey Jenkins is one mother who is grateful for the effort. Her oldest son, 13-year-old Sam, has epilepsy and is nonverbal due to developmental delays caused by frequent seizures earlier in his childhood.

"For my other kids, I can prepare them or walk them through what the process is going to look like," she said. "You can't prepare Sam for anything. So causing him pain is always a difficult decision."

During a series of blood draws a year ago, caregivers placed Sam under a heavy blanket and sedated him. They also played his favorite music — anything with a bass beat.

"It's kind of funny," his mother said. "He's a big Bob Marley fan."

The pain-free initiative applies to children with cancer and other diseases, who endure numerous blood draws and drug infusions, but also to healthy children who are supposed to receive more than a dozen immunization shots before they turn 3.

New technologies are emerging to address needle pain as well. A Georgia Tech researcher who has studied the causes of needle fears invented the "Buzzy," a device that resembles a bee and delivers cold and vibration to the skin to reduce injection pain.

At Gillette Children's hospital in St. Paul, staff members have tried virtual-reality masks and games to distract patients.

At Children's, other strategies include breast-feeding or bottle-feeding infants to calm them during injections.

Numbing cream containing lidocaine is a popular choice, but it creates a logistical challenge in outpatient clinics because it must be applied 30 minutes before an injection. Friedrichsdorf said one solution has been to coordinate with parents, who can buy cream over the counter and apply it before bringing their children to appointments.

Children's persuaded the Minnesota Department of Human Services to cover the numbing cream for injection procedures through its Medical Assistance program for low-income families. Friedrichsdorf said he suspects other insurers will do so as well, because reducing needle fears should increase the rate of immunizations and prevent infectious diseases.

Friedrichsdorf's study, published in the journal Pain Reports, showed that the Comfort Promise program hastened care, possibly because nurses spent less time negotiating with children before injections and consoling them afterward. Visits involving needle procedures at Children's outpatient labs declined on average from 20 minutes to 16 minutes.

Jeremy Olson • 612-673-7744