Reducing pain of children having nuclear medicine exams

Implementing multiple strategies to reduce pain can improve the experience of children receiving injections of radiotracers for nuclear medicine exams, according to researchers at the Hospital for Sick Children in Toronto, Ontario, Canada. Their retrospective study of pain experienced by 196 children, published in the July 17, 2019, online edition of Pediatric Radiology, suggests that combining two or more pharmacological interventions may be more effective than a single one.

Mandy L. Kohli, a radiologic technologist and instructor in nuclear medicine, and her colleagues at the hospital, conducted a retrospective study evaluate and compare the effectiveness of different pain reduction strategies. They reviewed the records of 114 girls and 82 boys who had nuclear medicine scans over four years to assess pain scores reported by children over the age of 7 using the Faces Pain Scale-Revised (FPS-R), or reported by a technologist for infants and children younger than 7.

The children were categorized into one of five groups:

• 50 who received topical liposomal lidocaine cream (Maxilene, RGR Pharma);
• 69 who received an instant topical anesthetic skin refrigerant spray (Pain Ease, Gebauer’s);
• 10 who received both Maxilene and Pain Ease;
• 48 infants up to 18 months of age who were administered oral sucrose (TootSweet, SandBox Medical); and,
• 19 who declined any intervention.

A variety of physical and psychological distractions were used with all patients. Physical strategies included deep breathing, massage, keeping patients warm, having patients sit on a parent’s lap or next to the parent, and rocking and swaddling for infants. Psychological strategies included diversions with books or storytelling and/or interaction with a child life specialist.

The authors also compared pain scores between intravenous cannulation or a butterfly needle use to administer radioactive tracers and pain scores based on number of attempts. They also compared these pain scores based on a child’s age.

The authors found that children who received some type of pharmacological intervention had an average pain score of 2.27 compared to 3.4 for children who did not have any intervention. The 10 children who received both Maxilene and Pain Ease had the lowest score, at 1.6.

Patients who required multiple attempts to administer the radiotracers had more painful experiences. The authors reported that patients requiring three attempts had a median score of 5.1 (with a range of 2.4 to 7.8) compared to those who only needed one attempt, at a median score of 2.2 (with a range of 0 to 4.6).

REFERENCE

1. Kohli ML, Vali R, Amirabadi A, et al. Procedural pain reduction strategies in paediatric nuclear medicine. Pediatr Radiol. Published online July 17, 2019. doi: 10.1007/s00247-019-04462-w.