When discussing the test with patients, the physician should reassure the patient and parents regarding the degree of pain that may be encountered, which is not materially different from venipuncture. Muscle Nerve 54: 422-426, 2016.
We thank Dr. Ruan for his interest in our publication. We appreciate the comments and want to address briefly the main question raised.Ruan's main concern was that we did not use any topical analgesics or local anesthetics before needle insertion. Primarily, the purpose of this study was not an attempt to minimize pain in children. From our daily experience, the test itself causes no significant distress, and with distraction, the majority of children will pass through it with no major problem. In fact, with a practice that exceeds 25 years and has seen numbers of referrals increase steadily from around 350 per year to a number that now approaches 1,000, one of the authors (M.C.P.) has never been asked for the study to be discontinued. These observations are still anecdotal, and for this reason, our aim was to give more substantive evidence with objective measurements to a long-held belief that the examination we perform in children is not unduly uncomfortable. The fact that we compared the pain experience with that of venipuncture, even though most blood tests in children are now conducted after application of local anesthetics, is further evidence of its relatively benign nature.Furthermore, the methodology we use with keeping the needle hidden and progression on to the needle insertion being smoothly and quickly performed after the end of the nerve conduction studies would be changed if we placed a local anesthetic at the site of the needle insertion. The children then would know that there was going to be a needle insertion, and we would have lost the opportunity of essentially deceiving them that anything unpleasant is going to happen.
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