Pain Clinical Trial
Official title:
Does Noninvasive Electrical Stimulation of Acupuncture Points (NESAP) Reduce Heelstick Pain in Infants?
The purpose of the study is to determine whether noninvasive electrical stimulation at
acupuncture points (NESAP) and/or 24% sucrose is effective in reducing pain in infants
during invasive procedures.
The investigators hypothesize that:
- Gentle noninvasive electrical stimulation at selected acupuncture points and/or oral
use of 24% sucrose with pacifier will reduce the newborn infant's responses to
heelstick pain, as measured by the Premature Infant Pain Profile (PIPP), heart rate
variability, duration of crying, and salivary cortisol levels.
- The effects of combined therapies will be additive.
- The analgesic effects of NESAP and/or sucrose will continue for the duration of the
heelstick, reflected by the first two minutes of heelstick and the first two minutes of
recovery.
A collaborative prospective, double-blind, randomized trial will be performed at the
University of Arkansas for Medical Sciences Hospital (Little Rock, AR), and Lucille Packard
Children's Hospital (Palo Alto, CA). After obtaining IRB approval at both sites and parental
consent, newborn infants less than 3 days of age who require heelsticks for clinical blood
sampling will be randomized in a 2 × 2 factorial trial design to four groups: standard pain
management with pacifier and water, Nonāinvasive Electrical Stimulation of Acupuncture
Points (NESAP) with pacifier and water, 24% oral sucrose solution with pacifier, or NESAP
plus oral sucrose solution and pacifier prior to their heelstick.
We will study the pain response to the heelstick routinely used to obtain blood for term
neonatal infants by enrolling up to 192 infants, 96 from University of Arkansas for Medical
Sciences and 96 from Lucille Packard Children's Hospital. This number will allow for screen
failures and withdrawals. A minimum of 164 infants collectively from both sites is required
to complete the study. Infants will be divided into 4 experimental groups:
1. Group A: Sham (fake electrical stimulation) plus sugar water with pacifier before
heelstick.
2. Group B: Electrical stimulation plus water with pacifier before heelstick.
3. Group C: Electrical stimulation plus sugar water with pacifier before heelstick.
4. Group D: Sham (fake electrical stimulation) plus water with pacifier before heelstick.
Electrical stimulation will be applied at appropriate acupuncture points using a very low
current for 10 minutes, routine for procedural pain. The response to pain will be assessed
using a pain scale, heart rate, heart rate variability and oxygen saturation changes,
duration of crying, and changes in salivary cortisol levels.
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