Pain management in children patient undergoing botulinum toxin injections.

Objective There is no consensus on the question of pain induced by injections of botulinum toxin in children. The objective of this study is the evaluation of our practice as well as the resources, which are employed to relieve children, in order to improve a better management of pain. Material/patients and methods This was a six month prospective observational monocentric study. The consent was obtained for each child. The main criterion was the hetero-evaluation of injection related pain with the modified scale FLACC. In parallel, parents evaluated their child pain as well as their anxiety; and injectors evaluated the quality of their act. Results Overall, 47 children from 2 to 18 years old, concerned with an indication of botulinum toxin injections, were included. Four hundred and twenty-two children were given during 49 sessions. Seventy-one percent of children received a premedication associating hydroxyzine, MEOPA ® and EMLA ® . Eight children were also accompanied by hypnoanalgesia, the others, distraction. The average pain during the injections was estimated with the FLACC to 2,632 (sd 1,892), the Digital Scale with 2.591 (sd 2,67). Children who presented an intense pain (FLACC > 7) during the session of injections were 14,28%. Thirty-three percent of children were worried or very worried. Injectors were unsatisfied with 33% of their sessions. No link was established between pain and: sex, prematurity, epilepsy, motor disability, premedication, injection's volume, localisation of injection, hypnotherapy or distraction support. Anxiety and pain were linked. Discussion - conclusion Anxiety must be detected and prevented as well as pain is. Progress is possible, but appropriate studies are still needed to help us to define collectively a protocol more adapted.