The growing literature on CAM methods of pain management with infants suggests that there are safe non-pharmacological methods of providing at least partial pain relief for infants during the often frequent and painful procedures they must routinely undergo. The mechanisms by which these methods reduce pain response are unclear, but may include the promotion of natural self-regulatory processes as well as sensory distraction. Nevertheless, as discussed subsequently, the quality of the evidence for some modalities remains relatively weak, as few investigators reported adequate blinding and standardization of methods. A summary of the main findings for each of the CAM interventions reviewed is presented subsequently.
The available evidence suggests that music therapy may hold promise in reducing pain among infants receiving heel sticks (). On the other hand, there is mixed support for the application of music for circumcision pain. It should be noted that only a handful of studies on the effects of music on infant procedural pain have been conducted and no research has yet examined the differential effects of live music therapy and recorded music. Further, it is unclear whether music is more effective as a distraction than visual, tactile, nutritive or other stimuli, or whether music may reduce distress through an additional mechanism other than distraction. Work addressing each of these questions is required.
KC is an appealing method of pain management in infants undergoing painful medical procedures and appears to be safe for both term and preterm infants (). However, only two trials on KC have been conducted, and the generalizability and standardization of this intervention is complicated by variations in maternal attitudes and comforting styles. In several trials, mothers introduced additional comforting techniques such as stroking or verbalization when providing KC, which exerted unknown effects. Moreover, Johnston et al.
) reported a 40% refusal rate among mothers, indicating that not all women were comfortable with the approach; women who are less comfortable may be less effective in relieving their newborns’ distress. Further research on this method and the variable impact of maternal style and attitude are indicated.
Use of a familiar pleasant smell is a low-risk, low-cost intervention that may distract the infant from procedural pain (). The two available trials showed that newborns familiarized to a vanillin scent evidenced reduced pain response during venipuncture, but not during heel sticks; however, the familiar smell of maternal breast milk was effective in providing analgesia for the latter. As with other research in this area, the evidence is qualified by the authors’ failure to provide for or explain observer-blinding procedures.
Four trials and one meta-analysis of unpublished research offer preliminary evidence for the efficacy of swaddling in managing pain and distress caused by heel sticks in preterm infants (). In each of these, however, assessments were done by a non-blinded observer, who, in some cases, also provided the intervention. All but one investigation employed a crossover design, but order effects were generally not examined. No reports have evaluated swaddling in full-term newborns or in painful procedures other than heel stick. It seems likely that swaddling, facilitated tucking or other interventions which gently support the baby in a naturally secure position may help to relieve procedural pain in neonates, but further well-designed research is needed.
Multisensory stimulation as tested by the Bellieni group in two reports appears to produce analgesic effects for both term and preterm infants undergoing heel sticks (). One major limitation of these trials however is their failure to fully blind observers. In addition, their larger 2002 investigation demonstrated that the saturation method without the administration of glucose caused infants to become irritable and to respond to the heel stick with increased signs of distress (47
). Bellieni and colleagues argued on the basis of this observation that sensorial saturation will be most effective if there is a ‘favorable background situation’ (p. 462)(47
), provided by the newborn sucking a sweet liquid. Yet, the Johnston group failed to find a similar ‘favorable background’ effect in their work on simulated rocking with sucrose; the addition of the sugar stimulus did not significantly enhance pain reduction (50
). It may be that specific stimuli alone provide a high degree of distraction or comfort, while the introduction of multiple unfamiliar and less comforting stimuli acts to heighten rather than distract the infant's attention. It is clear that further research on the incremental effects of individual components of the sensorial saturation package is necessary.