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About SickKids

September 4, 2007

Researchers find that despite evidence of efficacy, topical anesthetics are not commonly used for routine immunization

( TORONTO ) – Researchers at The Hospital for Sick Children (SickKids) have found that even though topical anesthetics have been shown to reduce pain during routine immunizations, they are not widely used by paediatricians. This research is reported in the September 4 issue of the journal Pediatrics.

Childhood immunizations are traumatic for children, their families, health care workers, and society at large. Beyond the acute injection and post-injection pain, repeated immunizations lead to pre-procedural anxiety and hypersensitivity to future painful procedures. In its most extreme form it can lead to avoidance of medical care because of “blood-injection-injury phobia.” The stress upon parents is also profound, leading some parents to become noncompliant with vaccine administration, which in turn contributes to the risk of resurgence of vaccine-preventable disease.

The trauma of having a painful needle experience can last a lifetime. Studies have shown that most needle phobias develop between the age of 4 and 6 and about 10 per cent of the population is needle phobic. More than 50 per cent of school aged children are afraid of needles

Topical anesthetics such EMLA cream (lidocaine-prilocaine) and Ametop gel (amethocaine) have been proven to be highly effective at reducing injection pain, however SickKids researchers found in a survey of physicians and parents that they were rarely used as part of their vaccination pain management strategy. Oral analgesics such as Tylenol (acetaminophen) and Advil (ibuprofen), however, were used more commonly to manage pain.

The researchers found these results surprising, because scientific evidence consistently supports topical local anesthetics for injection pain but such evidence is equivocal for the use of oral analgesics, which were used more frequently to manage injection and post-injection pain.

“Topical anesthetics do not prevent all pain, but they do reduce it, by about half” said Dr. Anna Taddio, the study's lead author and principal investigator, an adjunct scientist in Child Health Evaluative Sciences at the SickKids Research Institute and pharmacist, and an associate professor of Pharmacy at the Leslie Dan Faculty of Pharmacy at the University of Toronto. "There is an expectation that topical anesthetics make injections pain free. Since they do not, people have not adopted their use.”

Taddio noted that topical anesthetics take about 30-60 minutes to become effective which some paediatricians sited time as a barrier to use. Parents, on the other hand, reported that they were unfamiliar with topical local anesthetics, but had been informed about oral analgesics.

“The good news is that if doctors endorse the use of topical anesthetics, like they endorse the use of oral analgesics, patients would be more inclined to use them,” added Taddio.

Other researchers involved in this study were Jennifer Manley, Leah Potash and Moshe Ipp from SickKids, Michael Sgro of St. Michael's Hospital and Vibhuti Shah of Mt. Sinai Hospital.

This research was funded by the Canadian Pain Society, the Canadian Institutes of Health Research and SickKids Foundation.

The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, is Canada's most research-intensive hospital and the largest centre dedicated to improving children's health in the country. As innovators in child health, SickKids improves the health of children by integrating care, research and teaching. Our mission is to provide the best in complex and specialized care by creating scientific and clinical advancements, sharing our knowledge and expertise and championing the development of an accessible, comprehensive and sustainable child health system. For more information, please visit www.sickkids.ca. SickKids is committed to healthier children for a better world.

For more information, please contact:

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The Hospital for Sick Children
Phone: 416-813-6380
Fax: 416-813-5328