No Pain, No Gain? numbing pump & sensor sites
For many insulin pump users, infusion set applications cause little or no pain – just a short jab that doesn’t bother them in the least. The same is true for insertion of many Continuous Glucose Monitor (CGM) and Flash (Libre) sensors. However, some individuals, particularly children, may find the process distressing or even painful. The good news is that pain can be minimized - or even eliminated completely!
For a quick, easy solution, an ice cube rubbed over the pump or sensor site immediately before applying the infusion set or sensor numbs the area a bit and makes the experience more comfortable. A cold gel pack held on the area for a few moments can also help. However, some kids find the cold sensation uncomfortable, and this solution tends to “take the edge off” rather than blocking the pain.
2. Anesthetic Creams & Sprays
Another option is a topical anaesthetic cream, such as EMLA™ or Maxilene®. Topical anesthetics have a numbing effect and are used to block pain. A common numbing ingredient in topical anesthetics is lidocaine. Both EMLA™ and Maxilene® contain lidocaine in non-prescription strengths, which numbs the area temporarily, and can make the process of set changes virtually painless. You simply apply a dab of the cream (about the size of a dime), and then cover it with a first aid dressing, such as OPSITE™ Flexifix◊, Tegaderm™, or IV3000 for the specified period of time (15-30 mins). Then you remove the dressing, wipe away all of the cream, cleanse the skin, then apply the infusion set or sensor as usual.
Things to know about numbing creams:
- If you do use a topical anesthetic cream, you apply it (and remove it) before the use of any skin prep wipes.
- One brand name anesthetic cream, Maxilene,® is available in different strengths - the higher the concentration of lidocaine, the quicker it acts (and the higher the price). Maxilene® 4 has 4% Lidocaine, while Maxilene® 5 has (you guessed it) 5% Lidocaine. Either of these will numb quicker than creams with 2.5% Lidocaine, such as EMLA™ (which also contains an additional numbing agent, prilocaine, but still takes longer to take effect).
Tips from the Trenches
Both Danielle and I have used both EMLA™ and Maxilene® with good results. We leave EMLA™ on for about 45 minutes before a set change, while Maxilene® 4 seems to work in about 20 minutes, Maxilene® 5 in about 15 mins. In making a decision about whether and which type to use, in addition to discussing with your child’s doctor whether this solution fits for your child, you may also want to consider the economics of the different options... at publication time, Maxilene® 4 and EMLA™ cost about the same, but Maxilene® 4 works faster. (Which is valuable when we need to change the set before school, for example, but only have about 15 mins. to do so). Maxilene® 5 costs slightly more than the other two (about CA$5 more for a 30g tube), which may or may not be worth it to you. I encourage you to do some research and make the decision that’s best for your family. ~Michelle
How about spraying on a topical anesthetic to numb the infusion site? Gebauer's Pain Ease® is a "non-drug, non-flammable... instant topical anesthetic skin refrigerant approved to temporarily control the pain associated with needle procedures and minor surgical procedures."
Tips from the Trenches
Although we don't personally have experience with this spray, we have heard of families using it with good results. They report that each can of Pain Ease® has about 50 applications and that it numbs the area very quickly. It's important to note that the Risk and Safety Information cautions that "over-spraying may cause frostbite" and that "the thawing process may be painful", so be sure to use it according to the manufacturer's instructions. If you're interested in trying Pain Ease®, you could talk to your child's diabetes health care team, or contact your local pharmacy to order.
3. Auto Inserters
Also, infusion sets that use auto-inserters tend to insert the introducer-needle quicker and with the right pressure to minimize discomfort. If your child is struggling with set changes, consider using an insertion device (a.k.a. “serter”, or “auto-inserter”).
4. Competing Stimulus
Here's another (fun!) way to avoid insertion pain:
Buzzy® is a small device shaped like a bee character (or a ladybug, if you prefer) which acts as a physiologic pain blocker by using vibration and/or cold sensations to compete with the pain stimulus. Although it's not available in Canada*, it's worth mentioning because of it's theoretical basis, the Gate Control Theory of Pain Management, which proposes that our perception of pain can be altered by creating a non-painful sensation “gate” between the brain and the location of the painful stimulus; that gate blocks the pain from getting to the brain so that we don’t feel it. According to the Buzzy® website, “using cold and vibration, Buzzy® is proven to naturally block unpleasant sensations on contact”. To back that up, they have links to Buzzy's efficacy research on their website.
Even if you can't get your hands on an official Buzzy,® you could use the principle of a competing stimulus to create a DIY device using a hand-held massager and a cold pack.
(*At the time that this article was written, Buzzy would not ship to Canada because of a technicality with Health Canada's requirements for "medical devices.")
No Need to Numb?
For some health care professionals, the default approach is to only use interventions that are absolutely needed. After all, any intervention comes with some risks, as well as adding cost and effort to a situation that already demands much of our effort, time and money. For these individuals, numbing creams seem unnecessary; the answer to “why bother?” becomes “don’t bother”. However, in considering whether to use a topical anesthetic, it may be helpful to look at your family’s emotional needs, too.
Does your child get worked up when it’s time for a set change? Could she be stuffing down feelings of fear and building a negative association with set changes, and perhaps with diabetes overall? If not, then you don’t need to worry about fixing something that’s not broken. However, if you or your child dread changing infusion sets or sensors, then numbing creams may be a helpful solution. Our family's strategy is: if you can avoid the pain, then why not do so?
Tip from the Trenches
When we first started using infusion sets, we thought that the insertion would be quick and easy but Paul taught us different. His anxiety levels were so high and the crying so great with set changes that we thought we would try a different strategy. We bought some EMLA™ cream, which we affectionately termed “magic cream” and gave it a go. Paul’s initial response made us realize how stressed he had been over a set change. He was initially crying at the thought of the insertion but once I inserted it into the numbed area and he realized it didn’t hurt, he began laughing and exclaiming, “It didn’t hurt at all, Mommy!” I realized at that point just how stressed I had been over his anxiety and also felt relief when it didn’t have to hurt. We continued to use “magic cream” without any more infusion set changing battles until Paul was about 9 years old. At that point “he” decided he didn’t need it anymore. I’ve heard people say numbing isn’t needed, that kids will just get over it but fears and phobias aren’t rational, some kids (especially younger kids) don’t just get over it. The emotional upset can be avoided so why not avoid it? It’s important to decide for yourself based on your child’s anxiety levels whether or not numbing the site change area will benefit your child. ~Danielle
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.
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