BRING IN THE CLOWNS: MEDICAL CLOWNING IS EFFECTIVE IN REDUCING PAIN IN CHILDREN WITH CEREBRAL PALSY UNDERGOING BOTULINUM TOXIN INJECTIONS
הכניסו את הליצנים: ליצנות רפואית מפחיתה כאב בילדים עם שיתוק מוחין בשעת הזרקת רעלן הבוטוליניום.
הלה בן-פזי, נעמה קרוייזר, אברהם כהן, רננה לוטם- אופיר, יעקב שווילי, יהודה פולק
Hilla Ben-Pazi1, Naama Kroyzer1 , Avraham Cohen2, Renana Lotem- Ophir2, Yaakov Shvili 2, Yehuda Pollak1
1 Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
2 Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
Introduction: Children with cerebral palsy (CP) undergo multiple painful procedures such as Botulinum toxin (BTX) injections that are administered several times a year. While clown care reduces preoperative anxiety, little evidence has provided regarding its effect on painful procedures. Our objective was to assess if medical clowning reduces pain during BTX injections.
Materials & Methods: We enrolled 32 children with CP who underwent BTX injections (mean age 6 years 8 months, SD 4 years 6 months; 23 boys) in this randomized controlled trial. Each child was randomly assigned to receive either clown care (study) or standard care (control) intervention. Outcome measure was the Visual Analogue Scale (VAS) as reported by the child (n =17) or parent (n =15) prior and subsequent to each procedure.
Results: Whereas similar pain was anticipated prior to BTX injections, subsequently less pain was reported for children undergoing the procedure with clown care compared to standard care (p <0.001). While all children undergoing BTX with standard care reported severe pain (VAS≥4), the majority of children receiving clown care experienced lower pain levels (VAS<4, p < 0.001).
Conclusions: Medical clowns have the potential to alleviate pain during BTX injections and provide a non-invasive method for coping with discomfort during needle intervention in children with physical disabilities.