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A Randomized Comparative Effectiveness Study of Reflexology, Sucrose, and Other Treatments for Needle Procedures in Newborns

Authors: Us Mahmut Caner, Saran Mine Güneş, Cebeci Burcu, Akkuş Erkan, Şeker Esma, Aybar Şadiye Sezin ŞimşekJournal: Pediatric neurologyPublished: March 1, 2023DOI: 10.1016/j.pediatrneurol.2022.11.019
Strong EvidenceRandomized Controlled Trialn=300 participants

In Plain Language: reflexology, explained

Approximately 10 to 14 painful procedures per day are performed in infants during the hospital stay. We aimed to determine the effect of reflexology applied to the sole during painful procedures on pain perception in newborns compared with other nonpharmacologic methods. Our study was planned as a randomized controlled trial in term infants being followed up in the neonatal intensive care unit and maternity ward. To reduce pain during collection of venous blood or heel lance reflexology on the soles of the foot, 24% sucrose solution, kangaroo care, and classical music listening were applied to the infants. The Neonatal Infant Pain Scale (NIPS) was used to assess newborns during acute pain. A total of 300 patients were enrolled in the study. Higher pain scores and crying times were observed during heel blood collection. All analgesic methods significantly reduced NIPS scores during heel blood collection. Sucrose was the most effective method, followed by reflexology. The best method that significantly shortened the crying time was again sucrose solution followed by reflexology, kangaroo care, and classical music, during heel blood collection. However, none of the nonpharmacologic methods was effective during venous blood collection. Although sucrose was the most effective method, reflexology has significant positive effects, especially on average heartbeat, reducing pain, and shortening crying times during heel blood sampling. Reflexology might be considered among the nonpharmacologic methods to be applied before routine interventions, but still, there is a need for further studies to investigate the efficiency.

Key Findings: what this randomised trial found

  • ✓All nonpharmacologic analgesic methods (reflexology, sucrose, kangaroo care, and classical music) significantly reduced pain scores on the Neonatal Infant Pain Scale during heel blood collection in newborns.
  • ✓Sucrose solution was the most effective method for reducing pain during heel blood collection in newborns, followed by reflexology as the second most effective intervention.
  • ✓Heel blood collection procedures produced higher pain scores and longer crying times compared to other painful procedures performed in hospitalized newborns.

What This Means for You

If you're considering reflexology for newborn pain relief during medical procedures, research shows it may help moderately with certain types of blood tests, though sugar water remains more effective based on this study.

What This Means for Practitioners

Reflexology demonstrates measurable effectiveness as a non-pharmacological pain management tool for newborns during heel lance procedures, positioning it as a viable complementary option alongside other comfort measures in neonatal settings.

Study Design: how this randomised trial was run

Sample Size
300 participants
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Common questions about this study

What does this study mean in practice?

If you're considering reflexology for newborn pain relief during medical procedures, research shows it may help moderately with certain types of blood tests, though sugar water remains more effective based on this study.

What did this study find?

All nonpharmacologic analgesic methods (reflexology, sucrose, kangaroo care, and classical music) significantly reduced pain scores on the Neonatal Infant Pain Scale during heel blood collection in newborns. Sucrose solution was the most effective method for reducing pain during heel blood collection in newborns, followed by reflexology as the second most effective intervention. Heel blood collection procedures produced higher pain scores and longer crying times compared to other painful procedures performed in hospitalized newborns.

How strong is this evidence?

This is a randomised trial and we rate its evidence strong. It covers 300 participants. It was published in Pediatric neurology. Reflexology is a complementary therapy, not a replacement for medical treatment.

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