title: Pain during injections of botulinum toxin in children: Influence of the localization technique.
abstract: OBJECTIVE
  In this study, we consider two localization techniques used in injections of botulinium toxin in children: electrical stimulation and ultrasound. The hypothesis of this work was that injections performed without stimulation would be less painful.
  
  
  METHODS
  Monocentric prospective study, with 107 sessions of lower limb injections. Two groups of children were compared: localization by ultrasound only (60 children), detection by stimulation only or by stimulation combined with ultrasound (47 children). Pain assessment was performed by the child or an accompanying party using the Visual Analog Scale (VAS) and by a health care team using the Face, Legs, Activity, Cry, Consolability (FLACC).
  
  
  RESULTS
  A significant difference between the two groups was found in both self-report and by means of the behavioral observational pain scale. Indeed, VAS average and FLACC average were significantly higher with detection by stimulation than with ultrasound alone: 4.5cm±2.54 versus 2.7cm±2.27; P<0.001 for VAS scale and 3.7±2.1 versus 2.7±2.3; P<0.05 for FLACC scale.
  
  
  CONCLUSIONS
  When compared to ultrasound detection, localization by electrostimulation appears to increase the overall pain caused during injections of botulinum toxin in children.
authors.affiliation: Centre hospitalier de réadaptation de Maubreuil, 31, boulevard Salvador-Allende, CS 40401, 44819 Saint-Herblain cedex, France. Electronic address: m.mottu@ch-maubreuil.idhl.fr.
authors.forename: M
authors.initials: M
authors.lastname: Bayon-Mottu
authors.affiliation: Service de médecine physique et de réadaptation, centre hospitalier de Saintonge, 21, rue de l'Alma, BP 326, 17108 Saintes, France.
authors.forename: G
authors.initials: G
authors.lastname: Gambart
authors.affiliation: Centre de rééducation des Capucins, 49000 Angers, France.
authors.forename: X
authors.initials: X
authors.lastname: Deries
authors.affiliation: Centre de rééducation des Capucins, 49000 Angers, France.
authors.forename: C
authors.initials: C
authors.lastname: Tessiot
authors.affiliation: Centre de rééducation des Capucins, 49000 Angers, France; LUNAM, université d'Angers, département de médecine physique et de réadaptation, 49933 Angers, France.
authors.forename: I
authors.initials: I
authors.lastname: Richard
authors.affiliation: Centre de rééducation des Capucins, 49000 Angers, France; LUNAM, université d'Angers, département de médecine physique et de réadaptation, 49933 Angers, France.
authors.forename: M
authors.initials: M
authors.lastname: Dinomais
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004558:Electric Stimulation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects* / Q000379:methods; D035002:Lower Extremity; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging*; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Children; Douleur; Enfants; Localization technique; Pain; Repérage; Toxine botulique; Ultrasound; Échographie