Safely Managing Pain…

Pain Management is so important for all of us but especially for moms who are breastfeeding.

I just had a two day bout with a migraine so this article caught my attention.

I hope that it is helpful.

Pain is the most common reason that patients seek medical attention. Pain is a symptom with an extremely broad differential diagnosis. Effective treatments are based on proper diagnosis. The source, severity, and the cause of the pain need also be considered. There are several analgesics that can be used for a variety of pain syndromes. These include Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), opiates, and non-opiate drugs. For severe pain, the opiates are the preferred method of treatment. Morphine, codeine, hydrocodone, fentanyl, and hydromorphone have been determined, by several studies, to be moderately safe for breastfeeding women. However, morphine is the preferred opiate to use by a breastfeeding mother due to its poor oral bioavailability. Infants under one month of age need to be monitored closely for sedation since they take longer to clear the drug from their system; prolonged elimination half-life and decrease clearance. Additionally, hydrocodone should be used instead of codeine in the rare instance that the mother is an ultra-rapid metabolizer of codeine, which results in the break down of codeine into therapeutically excessive levels of morphine. Furthermore, morphine and hydrocodone have been studied extensively in lactating women and have demonstrated only occasional neonatal sedation. For mild to moderate pain or rheumatic pain, the NSAIDs are ideal. Studies have shown ibuprofen to be not only compatible with breastfeeding, but also extremely safe due to poor transfer into milk and safety in infants. Analgesics with long half-lives, such as naproxen, should be used for short durations due to the potential build-up of drug in the breastmilk. Drugs that contain salicylic acid, such as aspirin, should be used with caution. Studies have shown a direct correlation between Reye syndrome and the use of aspirin in infants and children. The use of 81 mg per day, however, is unlikely to increase the risk of this syndrome. Although there appears to be a low risk associated, aspirin is a poor choice for breastfeeding women due to its questionable nature. Ibuprofen or acetaminophen should be used instead. Acetaminophen and ibuprofen are both anti-pyretics that are compatible with breastfeeding and can be used to treat fevers as well.

Laura Muscianese MS1

Thomas W. Hale, Ph.D.

References: Hale TW. Berens P. Clinical Therapy in Breastfeeding Patients. Amarillo: Hale, 2010.

via Safely Managing Pain During Lactation | InfantRisk Center.

Can a Little Cough Ease the Pain of a Shot?

Parents…to reduce pain,check this out before your child goes for vaccinations !

“A study that was published in an issue of Pediatrics caught my eye . The title “Cough trick may reduce pain of routine immunizations” seemed relevant to my practice so I decided to preview the study a little early.

The study was performed at The University of Nebraska and involved 68 children (small sample size) and they were all receiving vaccines at either the pre-kindergarten visit (age four to five years) or at the 11 to12-year-old visit when routine immunizations are again given.

In this study the children were all instructed to COUGH while getting their vaccines and then the children as well as their parents and nurses were surveyed to see how painful the procedure seemed. For the kids they used visual scales (pictures of painful faces) to demonstrate degree of pain.

…. the time and cost was NONE as the children were taught to give one BIG cough prior to the injection and then coughed again at the time of injection. What a wonderful discovery! Easy, efficient and no training necessary for staff. In this study it wasn’t clear that it helped all children, and interestingly it seemed to be more effective in certain racial groups than others?

via Can a Little Cough Ease the Pain of a Shot? | The Kid’s Doctor: Your Partner in Parenting.