Ben-Pazi Hilla, Cohen Avraham, Kroyzer Naama, Lotem-Ophir Renana, Shvili Yaakov, Winter Gidon, Deutsch Lisa, Pollak Yehuda
Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
PLoS One. 2017 Apr 17;12(4):e0175028. doi: 10.1371/journal.pone.0175028. eCollection 2017.
We investigated the impact of clown-care on pain in 45 children with cerebral palsy who underwent recurrent Botulinum-toxin injections (age 7.04± 4.68 years). Participants were randomized to receive either clown (n = 20) or standard (n = 25) -care.
Pain Visual-Analogue-Scale (range 1-5) was reported before and after procedures. Pain assessment was lower for children undergoing Botulinum-toxin injections with clown-care (2.89± 1.36) compared to standard-care (3.85± 1.39; p = 0.036) even though pain anticipated prior to procedures was similar (~3).
Children who underwent the first procedure with clown-care reported lower pain even after they crossed-over to the following procedure which was standard (p = 0.048). Carryover effect was more prominent in injection-naïve children (p = 0.019) and during multiple procedures (p = 0.009). Prior pain experience correlated with pain in subsequent procedures only when first experience was standard-care (p = 0.001).
Clown-care alleviated pain sensation during Botulinum-toxin injections and initial clown-care experience reduced pain during subsequent injections even though clowns were not present.
clinicaltrials.gov ID # NCT01377883.
我们调查了小丑护理对45名接受反复肉毒杆菌毒素注射的脑瘫儿童（年龄7.04±4.68岁）疼痛的影响。参与者被随机分为接受小丑护理组（n = 20）或标准护理组（n = 25）。
在操作前后报告疼痛视觉模拟量表（范围1 - 5）。接受肉毒杆菌毒素注射的儿童，小丑护理组的疼痛评估（2.89±1.36）低于标准护理组（3.85±1.39；p = 0.036），尽管操作前预期的疼痛相似（约为3）。
首次接受小丑护理操作的儿童，即使在后续转为标准护理操作后，报告的疼痛也较低（p = 0.048）。在初次接受注射的儿童中（p = 0.019）以及在多次操作过程中（p = 0.009），延续效应更为显著。只有当首次经历为标准护理时，先前的疼痛经历才与后续操作中的疼痛相关（p = 0.001）。
小丑护理减轻了肉毒杆菌毒素注射期间的疼痛感，并且最初的小丑护理经历减少了后续注射时的疼痛，即使当时没有小丑在场。
clinicaltrials.gov标识符#NCT01377883。
