title: Prior leg massage decreases pain responses to heel stick in preterm babies.
abstract: OBJECTIVE
  Leg massage could inhibit the transmission of pain by 'closing the gate' or by activating the endogenous opioid pathway to decrease nociceptive transmission of pain associated with heel stick. The aim of this study is to determine the effects of massage therapy prior to heel stick on responses assessed by the Neonatal Infant Pain Scale (NIPS) (primary outcome), heart rate, respiratory rate and oxygen saturation (secondary outcomes) in infants who required a heel stick for blood sampling.
  
  
  METHODS
  This randomised, double-blind, crossover trial with infants from 1 to 7 days post birth excluded those with prior surgery, septicaemia, current assisted ventilation or an analgesic within 48 h. After informed consent, 13 infants received a 2-min massage of the ipsilateral leg prior to heel stick on the first study sampling and no massage on the next sampling 2-7 days later and 10 infants had the reverse order. The bedside nurse, blinded to the intervention, measured NIPS, heart rate, respiratory rate, and oxygen saturation prior to massage, after massage, and 5 min after heel stick. Serum cortisol was measured with the blood sampling.
  
  
  RESULTS
  In 23 infants (birthweight 795-2507 g), there were no adverse physiologic effects of massage. After heel stick, NIPS (P < 0.001) and heart rate (P = 0.03) were increased in the no-massage group compared with the massage group. Respiratory rate, oxygen saturation and serum cortisol were not significantly different.
  
  
  CONCLUSIONS
  Gentle massage of the leg prior to heel stick is safe and decreases pain responses in preterm infants.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: Sunil
authors.initials: S
authors.lastname: Jain
authors.forename: Praveen
authors.initials: P
authors.lastname: Kumar
authors.forename: Douglas D
authors.initials: DD
authors.lastname: McMillan
mesh_terms: D001800:Blood Specimen Collection / Q000009:adverse effects / Q000379:methods*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007866:Leg; D008405:Massage; D010100:Oxygen / Q000097:blood; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods
chemical_list: D010100:Oxygen; D006854:Hydrocortisone