The Efficacy of Distraction and Counterstimulation in the Reduction of Pain Reaction to Intraoral Injection by Pediatric Patients

Aminabadi, Naser Asl; Farahani, Ramin Mostofi Zadeh; Gajan, Esrafil Balayi

doi:10.5005/jcdp-9-6-33

Cited by 28 publications

(31 citation statements)

References 15 publications

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“…Perhaps the most dramatic example of hypervigilance in rodents occurs when naive animals observe painful responses in cagemates and then execute hyperalgesic responses themselves (Langford et al, 2006). A variety of interventions at the supraspinal, cognitive processing level, including food distraction, stabilizes sensory perception in humans and animals by tempering hypervigilant behavior (Aminabadi et al, 2008; Casey and Morrow, 1983; Ford et al, 2008; Hoffman et al, 2008) and potentially modulating mu opioid receptors (Fields, 2004; Mason, 2005). While food distraction does not completely eliminate threshold decay in our hands, it provides important evidence that our below-level testing methods are likely capturing supraspinal involvement associated with the withdrawal response.…”

Section: Discussionmentioning

confidence: 99%

Validity of acute and chronic tactile sensory testing after spinal cord injury in rats

Detloff

Clark

Hutchinson

et al. 2010

Experimental Neurology

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Spinal cord injury (SCI) impairs sensory systems causing allodynia. Measuring the development of allodynia in rodent models of SCI is challenging due to spinal shock and marked motor impairments. Assessment of SCI-induced allodynia is not standardized across labs, making interpretation of results difficult. Therefore, we validated sensory threshold assessment after SCI and developed a novel assessment of allodynia prior to motor recovery in a rat SCI model. One hundred fifty-six Sprague–Dawley rats received T8 laminectomy or mild to moderate SCI using the OSU SCI device (0.3 mm to 1.3mm cord displacement). To determine tactile thresholds, von Frey hairs (VFH) were applied in Up–Down or ascending order to the dorsal or plantar hindpaw. The most efficient and valid procedures that maintain high sensitivity and specificity were identified. Ten Up–Down VFH applications yielded stable thresholds; reducing the risk of threshold decay and unnecessary exposure to painful stimuli. Importantly, distraction of SCI-rats with food revealed differential decay of thresholds than when distraction is not provided. The new test uses dorsal VFH stimulation and is independent of trunk or hindlimb control. Acute dorsal VFH thresholds collected before recovery of hindlimb weight support accurately predicted plantar VFH thresholds measured at late timepoints (χ2=8.479; p<0.05). Thus, standardized testing early after SCI using the dorsal VFH test or later using 10 stimuli in the Up–Down test produces valid measures of tactile sensation across many SCI severities. Early detection of allodynia in experimental SCI will allow identification of mechanisms responsible for pain development and determine targets for therapeutic interventions.

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Section: Discussionmentioning

confidence: 99%

Validity of acute and chronic tactile sensory testing after spinal cord injury in rats

Detloff

Clark

Hutchinson

et al. 2010

Experimental Neurology

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“…Distraction and counterstimulation methods were used during the injections. Counterstimulation involved the use of the thumb to create vibration with slight pressure on the soft tissue adjacent to the injection site (16). The range of vibration movement was approximately 1 mm (short back and forth / up and down movements) and the frequency of vibration was 1 cycle/s.…”

Section: Management During Intraoral Injectionmentioning

confidence: 99%

Site-specificity of pain sensitivity to intraoral anesthetic injections in children

2009

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A total of 455 children (242 males and 213 females) aged 5-6 years were investigated for their pain reactions to maxillary and mandibular infiltration anesthesia, middle superior alveolar nerve block, posterior superior alveolar nerve block, greater palatine nerve block, nasopalatine nerve block, and inferior alveolar nerve block, and the responses were quantified using the sound, eye and motor (SEM) scale. Administration of nasopalatine nerve block produced maximum pain (median SEM score: 10) while that of posterior superior alveolar nerve block and inferior alveolar nerve block was accompanied by minimum pain (3 and 4, respectively). There was no significant gender-specific difference in pain reactions (P = 0.39). Administration of local anesthesia in the maxilla was more painful than injections into the mandible (7 versus 5, P < 0.05). Furthermore, infiltration into the anterior and posterior segments of the maxilla produced maximum and minimum pain reactions, respectively (8 versus 3, P < 0.001). It seems that the anatomical location of an injection is one of the most important determinants of pediatric pain reaction, and that mandibular injections are generally less painful. Prioritization of treatment by consideration of site-dependent variability in pain sensitivity may help to achieve optimal behavioral control during dental treatment in young children.

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“…This is because a tense patient with an increased anticipation of pain usually feels more intense pain during local anesthesia 30) . Counter-stimulation, and distraction were used with all children of the study, as it has been shown that these techniques effectively reduce the pain reaction of pediatric patients during anesthetic injection 12,13) . Dental injections are associated with pain and discomfort by the patient.…”

Section: Discussionmentioning

confidence: 99%

“…After a few seconds, the needle was slowly advanced in the mucobuccal fold toward the apex of the molar and three quarters of the anesthetic solution was given. Distraction and counter-stimulation methods were used during the injections 12,13) . While I was administering anesthesia, I verbally communicated with the child and continuously encouraged him to After buccal infiltration, any child with behavior change other than Frankl 3 or 4 (uncooperative), was excluded from the study.…”

Section: Palatal Anesthetic Injectionmentioning

confidence: 99%

“…A number of complementary methods have been suggested to reduce the pain induced by infiltration anesthesia. These include distraction techniques 12) , counter-stimulation 13) , warming the anesthetic solution 14) , varying the rates of infiltration 15) , buffering the local anesthesia, and a reduced speed of injection 16) . Also, the efficacy of these methods in reducing the pain reaction is a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

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Pain assessment of two palatal anesthetic techniques and their effects on the child's behavior

Abdellatif

2011

Pediatric Dental Journal

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The purposes of the study were to: compare the pain perception and the behavior of children, who received palatal anesthesia by the direct and indirect infiltration anesthetic techniques, correlate between pain scores and behavior, and to make some recommendations for clinical practice. Sixty-two cooperative children aged 6 to 7 years participated successfully in the study. Each child received palatal anesthesia by both injection techniques to extract their badly destructed upper primary molars in two visits. Immediately after injection, the Wong and Baker pain faces scale was used for pain scoring by children. There were 32 boys and 30 girls (mean age 6 years and 3 months). The tested parameters were; pain perception and children's behavior during injection and pain perception during extraction. Comparisons between the effects of the two techniques within the gender and the tooth type were statistically performed using Chi-square test. Generally, no significant differences were found between the genders regarding neither pain perception nor behavior. For all children, the indirect technique significantly revealed lower anesthesia pain scores, and significantly more children displayed good behavior (P=0.031, P=0.004). No significant difference was reported in extraction pain scores between the two techniques, indicating the same efficacy of anesthesia was obtained. The second primary molar, significantly revealed lower pain scores of both anesthesia and extraction and a better behavior display of children anesthetized by the indirect rather than the direct technique (P=0.04, P=0.019, P=0.046). On the other hand, no differences were revealed on anesthetizing the first primary molar. Children's behavior was negatively correlated (r= 10.294) with anesthesia pain scores (P≤0.001). The results of the study recommend the use of the indirect palatal anesthetic technique for extracting the second primary molars and the use of the direct technique for extracting the first primary molars of young children. for the delivery of local anesthetic and is commonly addressed by the use of topical anesthetics. However, pain suppression following such use has been highly variable 3). An effective topical agent to reduce pain during local anesthesia of the palate is not yet available 4). Also, the additional time of application may increase the child apprehension and the taste of the topical anesthetic may be not pleasant for many children ending with disappointing management failure 5). Transoral lidocaine delivery system for intraoral use has led to a new approach for topical anesthesia 6) .

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The Efficacy of Distraction and Counterstimulation in the Reduction of Pain Reaction to Intraoral Injection by Pediatric Patients

Cited by 28 publications

References 15 publications

Validity of acute and chronic tactile sensory testing after spinal cord injury in rats

Validity of acute and chronic tactile sensory testing after spinal cord injury in rats

Site-specificity of pain sensitivity to intraoral anesthetic injections in children

Pain assessment of two palatal anesthetic techniques and their effects on the child's behavior

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