Needle Pokes and Procedural Pain Management
*I DID NOT MAKE THIS, IT WAS A FORMER COLLEAGUE
Background Info
Preparation is key to managing pain, medical anxiety, implementing pain management strategies
Creating a plan ahead of time helps kids manage anxiety by allowing them to figure out how they will be most comfortable and how they want to cope with managing pain and medical procedures, like needle pokes
Offers kids and their families a sense of control
What is pain, why do we have it, where does it come from?
Pain = biological, psychological, social experience
Why pain management matters
Distress and anxiety associated with medical procedures à can cause medical trauma, medical phobias, health care avoidance – role of motivation AND still having fears
Under-treated pain and anxiety à healthcare avoidance
Research tells us that short term suffering and long-term effects are preventable
“You are the boss of your brain”
Talk about Importance of Planning for visits
Even making small changes before a visit can be so helpful!
Discussing plan before their visit is key
Barriers = negative expectations and anticipatory anxiety
Send SuperMeg digital tools during appointments (https://www.nxtbook.com/nxtbooks/megfoundationforpain/toolkit_2021/index.php#/p/Cover1)
SuperMeg Poke Plan Builder – everyone to take 2 minutes and think about what your plan would be (after all potential info) – how can they actually do this and implement this?
SuperMeg Pain Champion Guide – what are the things that you’re going to do? Write it down
Providers ask for patients’ comfort plans
“Set the Stage” checklist
During appointments, ask kids for Poke Plan and review
Emphasize child’s power, choice, and control
“Action is the enemy of anxiety”
Encourage rewards
Coach caregivers to support child’s chosen pain management strategies
PRAISE
What happens after matters
Research indicates that what is said to kids after their medical experience will help form their memory of the experience.
This influences how kids remember their experiences and how they will feel about future medical interventions
“You did a great job sitting still!” “Nice work being brave!”
During visits – Pain management strategies
Comfort positioning
Children do best when held upright by a trusted adult/caregiver
Physical touch and presence can help cause positive physiological changes that lower pain and distress
Use the guide
Words matter
“Would you like to sit on dad’s lap? Does another position sound better? Take a look at this guide and choose the one that looks most comfortable”
“You can feel that mom is calm, right? Let her know if it would be helpful if she sang to you or rubbed your back”
Topical anesthetics (i.e., numbing cream)
Helps to reduce pain from injections and other needle procedures
Prescription and over the counter
Apply to skin 20-60 minutes ahead of time
Provides psychological comfort, as children know something is “being done” to help with the needle poke procedure
Distraction à practice in session – share how it went
Change the focus of attention à change the way that your body/brain process pain signals
Can lessen fear/anxiety before the needle poke
Kids naturally have the ability to get lost in toys, games, books, etc.
Choice is power!
Encourage distraction before and during the poke
Comment on distraction choices (“nice, I love pokemon too!”)
Involve parent in the distraction if possible, which can lower parental anxiety thus lowering the child’s anxiety
Word’s matter:
“I can tell that you are loving this activity! Pay attention to what feels good right now and don’t worry about me. Nice job taking care of yourself!”
Vibration
Nerve signals reach the brain for people to experience pain
Vibration reduces pain and increases comfort by interrupting those signals
Like a “neurological traffic jam” à pitting the nerve stimulation from vibration against the nerve stimulation from pain
Encourage kids to play with the distraction device so it doesn’t startle them and can serve as a distraction too
Buzzy Bee is most commonly used
Helpful to show kids how vibration works before the procedure to increase confidence and calm
Breathing à practice in session –
share how it went
Diaphragmatic breathing
Using bubbles and pinwheels is helpful with young children
Time the exhale with the needle insertion à most effective
Guided Imagery à practice in session – share how it went
A Word About Stress
Stress is contagious
Long wait times, watching other people get poked, hearing others’ reactions while in the waiting room can trigger stress responses
“Parent filtering” can help!
Highly anxious kids can wait in car and get a text when ready for their poke
Have materials ready to go for the poke once kid enters the procedure room
Privacy when possible
Have engaging/distraction items ready
Pain Champions Guide for Parents (https://www.megfoundationforpain.org/2022/07/20/pain-champions/)
SuperMeg Poke Planner (https://www.megfoundationforpain.org/2022/08/01/supermeg/)