The development of pain is described by the “gate control theory of pain” (Melzack & Wall, 1965). Pain is perceived by the a neural mechanism found at the dorsal horn of the spinal cord, acting like a gate modulating the flow of nerve impulse to the central nervous system (CNS). The pain stimuli are felt by nociceptors, nerve endings in the somatic and visceral tissues pain signals to the brain when pain stimuli are present. Three key processes in the mechanisms of pain have been identified (Cervero, 2009). How sucrose blocks these processes, remain to be seen.
Researchers have admitted that knowledge on sucrose’s pain –blocking mechanism was largely anecdotal at the onset. Nevertheless, a large body of evidence exists on the positive role of sucrose on reducing pain in children (Taddio, et al. , 2008) (Hatfield, Dyer, & Polomano, 2008) (Stevens, Yamada, & Ohlsson, 2004). Sucrose is a good intervention because it is easily available, good tasting, and most importantly, well liked by children. In the case of this experiment, it is similar to many experiments that have used sucrose as intervention; however, the only difference was the application.
While other studies have focused on newborn procedures like Vitamin K injections and heel lance procedure for newborn screening, this paper tested the utility of sucrose for older children undergoing immunizations. This is a good application because most of immunizations are administered by injections, are painful, and the pain is repeated because of the number of immunizations required in the first two years of life. Pain Assessment The main objective of this paper was to determine the efficacy of sucrose solution in alleviating pain during immunization.
Since young children do not have the verbal capacity to express their pain, several techniques have been developed to assess children’s pain (Walco & Goldschneider, 2008) (Malviya, 2006). Although the literature is replete with pain scales, the scale chosen must be appropriate for the child’s age like behaviour scales or face scales (Buttner & Finke, 2000). The pain assessment tool used in this article was the University of Wisconsin Children’s Hospital (UWCH) Pain Scale. It is a scale that was primarily developed for nonverbal and preverbal children (Soetenga, Frank, & Pellino, 1999).
This scale was developed because of the difficulty in assessment of pain even in adults who have the capacity for self-report or discussing the level of pain that they feel. In pain assessment in children both physiologic and behavioural indicators have been used but the former, such as blood pressure, heart and respiratory rates, are only useful when acute pain is present. When there is continuous pain, physiologic measures lose their utility because the patient’s constitution will adapt to a new baseline.
Behavioural categories also used in assessing pain and include facial expressions, body movements, crying. The UWCH Pain Scale using a 0-5 scale was developed to measure pain in very young children who are nonverbal and preverbal. It makes use of behavioural categories that are distinct and common to infants as follows: sleep, facial expression, vocal/cry, movement/posture, and behavioural/consolability. In each category are four descriptors. The scale was tested in fifty-nine preverbal children and was found to have high validity and reliability (Soetenga, Frank, & Pellino, 1999).
However, the categorical scoring limits the scale’s precision. Although it is recommended that pain assessment techniques should be incorporated into clinical practice, clinicians should also develop the ability to discern pain behaviours (Malviya, 2006). Nevertheless, the scale was used in this research study because it is easy and convenient to use, the interrater reliability was high and most important, and the principal investigator was highly proficient and skilled in its use.
Skill in using the tool is a major determinant in reliability of the results, especially when the test subjects are humans, and more so if they are infants. Results The results of the study were consistently in agreement with outcomes of previous studies on the use of sucrose as analgesia in very young infants (Hatfield, Dyer, & Polomano, 2008) (Taddio, et al. , 2008) (Stevens, Yamada, & Ohlsson, 2004). The results showed that giving sucrose to children at two minutes before their immunization shots did not reduce pain at the time when the shots were given, but three minutes after.
There was a 90% reduction in pain in the sucrose group compared to the control group. However, after two months, when the second set of immunizations were given, the results were the same, meaning that age did not change the response to the pain, despite the fact that the patients were older. However, the author pointed out that although the data was not significantly affected by the age of the infants, there was a slight increase in pain in the four-month-old sucrose-treated infants.
Such a conjecture is not supported by the data and the statistical analysis performed, and could have been due to a preconceived notion by the researcher considering that sucrose is not administered to older children. This aspect of the research results is worth pursuing; an aspect would be to investigate the effect of using higher doses of sucrose as the patients’ age increases. Results of the study are well supported by the statistical analyses. Thus, it is safe to pronounce that the results are valid and could serve as the basis for change in clinical practice and patient care.