BOTOX and Dermal Fillers Can Be Less Painful

We all know that patients are looking for non-surgical cosmetic procedures in preparation for the holidays. BOTOX and dermal fillers are two of the most popular pre-holiday cosmetic procedures. Any procedural protocol that we can adopt to make these needle procedures less painful and less anxiety inducing is good for our patients and good for our practice.

Two studies have specifically shown that a vapocoolant such as Gebauer’s Pain Ease can significantly reduce pain, discomfort and anxiety associated with the botulinum toxin type A injections [1,2].

For more information about how to incorporate the use of Gebauer’s Pain Ease in your Cosmetic practice go to the Gebauer’s Pain Ease Website .

1. Weiss, R. & Lavin, P. Reduction of pain and anxiety prior to botulinum toxin injections.
Unpublished manuscript, July 23, 2006. With permission.

2. Zins, J, Engel, SJ. Pain Relief of Botulinum Toxin Injection Using A Topical Anesthetic
Skin Refrigerant. Unpublished manuscript. With permission.

Emergency Department Wait Times

It’s no secret that Emergency Departments across the country are full. ED clinicians are treating patients seeking care for a wide variety of issues, and as a result, wait times have become an increasingly important factor for patients to decide which Emergency Department to visit.  Overcrowding has resulted in excessively long wait times for some.

Hospital Corporation of America’s East Florida Division has responded by reporting their wait times through an RSS feed on their website, on billboards and via an iPhone app.

Announcing your wait time is great as long as it is a short one. That means that effective ED managers are looking for ways to decrease that wait time. Some are utilizing new techniques for pain management that work faster than traditional local anesthesia. Gebauer’s Pain Ease is one of those methods.

Pain Ease instantly controls pain associated with needle procedures and minor surgical procedures such as incision and drainage of small abscesses, lancing boils, foreign body removal, suturing and suture removal, IV starts, blood draws, and injections including pre-lidocaine injections. In some cases it can be used effectively instead of a lidocaine injection.

To find out more about this topical anesthetic go to the Gebauer’s Pain Ease website

You can see the RSS feed on the HCC website.

Reducing Immunization Discomfort

Great News from a New Study
A new study points to “Reducing Immunization Discomfort in 4 to 6-Year-Old Children.” This randomized clinical trial, published in Pediatrics: The Official Journal of the American Academy of Pediatrics, “evaluates a unique approach that combines verbal suggestions of diminished sensation, a visually focusing activity, and a topical analgesic spray to diminish injection discomfort in 4 to 6-year-old children.”[1]

The conclusion? “This multifaceted distraction intervention reduced significantly the pain and discomfort of childhood immunizations in children 4 to 6 years of age.”1 And it cited the use of ethyl chloride as “an established pain-reducing measure.”[1] Click here to read more about this research.

The topical analgesic spray used in this study was Gebauer’s Ethyl Chloride®. The FDA has determined that each of the Gebauer family of topical anesthetic skin refrigerants is substantially equivalent (SE) to each other. Therefore this clinical reference is relevant to all Gebauer skin refrigerants, including Gebauer’s Pain Ease®.
One of the study’s author’s, F. Ralph Berberich, MD, FAAP, has also created a video of the distraction technique used in pediatric vaccination pain management. Click here to see Dr. Berberich and hear more about this technique. http://www.gebauerspainease.com/Pediatric-Video-%281%29.aspx

[1]Berberich FR, Landman Z.  Reducing immunization discomfort in 4-to-6- year old children: a randomized trial.
Pediatrics, 2009, August; 124(2); e203-209. Epub 2009 Jul 13.

Happy Thanksgiving

Happy Thanksgiving to all. Enjoy.

Pain Intensity Scales

Looking for pain intensity scales? The National Institute of Health Pain Consortium has compiled them in PDF form. They have the Numeric Rating Scale, the Wong-Baker Faces, the COMFORT scale, The CRIES Pain Scale and The FLACC scale.

Here is the link that takes you straight to the page with the PDF’s

http://painconsortium.nih.gov/pain_scales/index.html

Cool sensation aids in pain-free flu shots at Discount Drug Mart

I was recently interviewed by By Cheryl Powell at The Akron Beacon Journal, Ohio for an article that talks about a Discount Drug Mart who is choosing to differentiate themselves from other flu shot clinics by providing “a free spritz of Pain Ease before seasonal influenza shots during in-store clinics this fall.”   Tom Nameth, Discount Drug Mart’s director of pharmacy operations, estimates “40 percent to 45 percent of customers are getting it.”  The article quotes pharmacists and customers.  Here is a link to the article from The Akron Beacon Journal if you would like to hear what they had to say.

http://www.ohio.com/news/64448272.html

Pain Ease Utilized to Reduce Pain Associated with Cortisteroid Injections.

When non-invasive measures like NSAID’s and immobilization fail to reduce or eliminate the joint pain associated with inflammation, physicians may choose cortisteroid injection – a procedure that can be easily accomplished in the physician’s office and can provide relief for months or years of relief. It can sometimes eliminate or postpone the need for surgery. Many patients fear the injection due to the pain associated with it.

It is my contention that many patients wait too long to seek treatment because of the fear of the injection. I believe that if patient’s anxiety can be reduced they will be more likely to seek treatment sooner resulting in better health for the patient and less trauma to the body that is associated with chronic pain.

Dr. James McNabb, a family physician, understands that there is not need for pain to be incurred with needle procedures. He uses Gebauer’s Pain Ease topical anesthetic as a fast, and effective way to temporarily reduce/eliminate pain associated with injections. Dr. McNabb has produced an educational video showing his use of Pain Ease in a cortisteroid injection to the knee joint of a patient – one of the most common sites for cortisteroid injection.

I think it’s easy to see from the video that the patient is comfortable throughout the entire process. Check out this video and see if you agree that this patient experienced a pain-free needle procedure with little or no anxiety.

Here is the link to the video:  http://www.gebauerspainease.com/McNabb-Video.aspx

From the ENA STAT Conference

I was at the ENA STAT Conference and came back energized and filled with new ideas. Denise Ramponi, MSN, CRNP, CEN, DNP-S, presented a session titled “Reducing Pediatric Procedural Pain in the Emergency Department.” During the session she encouraged us to “be advocates for your pediatric patients to reduce their pain.” She also reminded us that, “Poorly managed pain has both long-term and short-term negative effects on children.”

She reviewed a number of non-pharmacological methods. Family presence: evidence suggeststhat parents should be allowed to be present with their children during minor procedures. Parents should be given specific instructions including methodsto minimize distress including maintaining a calm and positive atmosphere.

Verbalizations: reassuring comments, although instinctual, is ineffective and should be avoided because it increases distress in children. Examples of these reassuring comments that should be avoided include “You can do this”; “Don’t worry”‘ or “You’re okay”. She commented that we should state what we want the child should do, such as “Try to hold still”, “Try to blow the hurt away”. Avoid telling the child what they should not do; such as “Don’t move”, which evokes fear in the child.

Positioning: forcing a child to lay supine often results in panic, crying and strubbling. Comfort positions,such as sitting chest to chest or sitting in the parent’s lap, allow the parent to participate in a positive, supportive manner.

Distraction: distractors should be developmentally appropriate, such as books, blowing bubbles, games, can capture the child’s interest and be helpful in procedures. She reviewed a variety of pharmacological methods include the use of topical local anesthetics. Topical anesthetics should be considered before performing simple minor procedrues, such as venipunctures, IV starts, laceration repair, insertion of foley catheters, and lumbar punctures.

Given the strong evidence that topical local anesthetics greatly reduce pain and distress associated with venipunctures and IV starts, it should be standard practice for non-emergent needle procedures.

A Resolution on “Improving pediatric procedural pain management in the Emergency Department Setting” was presented at the General Assembly by ENA members: Denise Ramponi, CRNP, CEN, DNP-S of Pittsburgh, PA and Rhonda Morgan, MSN, CEN, DNP-S of Ashville, TN to the 800 voting members of the ENA General Assembly. It was suggested that ENA adopt a Pediatric Procedural Pain Management Position statement. It also suggested that ENA provide a template for safe and effective methods of pain management for children undergoing painful procedures. The General Assembly voted to adoped this Resolution and we look forward to ENA’s guidance in improving the management of pain in our pediatric patients in the emergency setting.

In this session attendees learned about using positive language with children, explaining calmly what you need them to do, rather than harsh instructions like “Hold still!” or “This is going to hurt.” She also talked about positioning and its importance in reducing anxiety and pain, as well as some topical anesthetics that are appropriate for children.

It was a very informative and insightful session for anyone who works with pediatric patients.

 

Take the Sting Out of the H1N1 Flu Shot.

I recently ran across a statement made by Kathleen Sebelius, Secretary, on Preparing for the 2009-2010 Influenza Season before Committee on Energy and Commerce United States House of Representatives, Tuesday, September 15, 2009. She said, “The federal government is also preparing for a voluntary national vaccination campaign for the 2009 H1N1 virus starting in October.  … One-hundred ninety-five (195) million doses of H1N1 vaccine have been purchased from five manufacturers by the U.S. government.”

That’s a lot of shots! And it’s my impression that American’s are nervous about H1N1. That’s why I think we should eliminate their apprehension of receiving the injection that could potentially save their lives and mitigate the possibility of a pandemic.  We can easily and cost-effectively take the sting out of the shot. Gebauer’s Pain Ease is a topical anesthetic that is proven to reduce the pain and anxiety associated with injections.  For more information go to www.gebauerspainease.com.

You can read the entire statement made by Ms. Sebelius at www.hhs.gov

2009 ENA Annual Conference – STAT

I am excited about being at the 2009 ENA Annual Conference – STAT Strengthen, Transform and Transcend. As a proponent of effective pain management, I am particularly interested in the course titled, Reducing Pediatric Procedural Pain in the Emergency Department. It will be taught by Denise Ramponi, RN, MSN, CRNP, CEN. The course is described as follows: “Pediatric patients often experience pain related to the procedures performed on them during their emergency department visit. Tools and tips regarding positioning, distraction techniques, verbalizations, and pharmacological methods to reduce pain in pediatric procedures will be provided.”

The Gebeaur Company will be exhibiting at the STAT Scientific Assembly, Booth #807. Attendees can learn more about Gebauer’s Pain Ease, a vapocoolant that is an effective topical anesthetic for emergency departments.

For more information about the conference go to www.ena.org