CUNY Medicine Students Lead Comprehensive Study On Topical Treatments For Pediatric Pain Management

March 28, 2024

Children are often scared of the pain when they need to get a shot or have a tube inserted for a medical procedure.

To help alleviate the discomfort and associated fear, doctors rub a numbing cream to the area before inserting the device. But which topical anesthetic best remains a topic of debate until a team of third-year medical students from the CUNY School of Medicine in Harlem investigated the matter.

For a systemic review published in March in SpringerNature, the research team—led by Kathryn S. Varghese—carried out the most comprehensive pooled analysis of trials comparing the two most popular treatments: EMLA cream (for eutectic mixture of local anesthetics) and amethocaine gel.

Ms. Varghese said she was motivated to frame this study after shadowing at the Bellevue Pediatric Emergency Department at NYU one summer. “The rationale behind the medications’ popularity was ambiguous, seemingly influenced by individual preferences,” she said. “I pondered whether it was possible to refine the existing literature to definitively address this question and determine which is best,” she said. Ms. Varghese has wanted to be a pediatric physician since middle school, with interests in pediatric emergency medicine and pediatric cardiology. “My passion for medicine is rooted in my love for children, their stories, and the experiences that shape their development,” she said.

Collaboration Proves a Successful Model for Student Research

Adham Ahmed, a co-author on the paper, said that various groups of classmates have been collaborating on meta-analysis research projects for several years now, leading to publications such as this one. “Our approach has always been to start with a question of interest and one that is timely to the field,” he said. “We then distribute our workload amongst our many CUNY Medicine student researchers, including defined tasks such as study screening, manual data extraction, statistical analysis, and manuscript drafting and formatting.” Since adopting this approach in 2021, he said students have published about a dozen manuscripts that have been shared in Pubmed-indexed medical journals.

For the pediatric pain-management study, the researchers focused on the following outcomes: first-attempt cannulation (tube insertion) success, child-reported visual analogue scale (VAS) score, parent-reported VAS score, observed pain score, child-reported absence of pain, and child-reported acceptable anesthesia. (VAS is a scale of 0 to 10 representing increasing severity of pain.) A total of 1,471 studies were identified and gathered for further study. 

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A clear winner emerged: amethocaine gel outperformed EMLA cream across several metrics. Notably, children who received amethocaine gel reported a higher rate of pain absence and achieved greater success in first-attempt cannulation. The research team also included Dave Mathew, and Peter Fusco—both third-year CUNY Medicine students—and Ms. Varghese’s mentor, Mabel N. Abraham, PhD, at the Feinstein Institutes for Medical Research.

Wider Implications for the Students’ Findings

CUNY Medicine’s Dean Carmen Renée Green, MD, who is an anesthesiologist and widely cited expert in pain-management and healthcare disparities, praised the student researchers for their pioneering work. “As future physicians and practicing doctors, these are exactly the questions we should be asking. Healthcare decision-making should always be evidence based,” she said. “The dedication and rigor demonstrated by this team of students exemplifies the spirit of inquiry and innovation that defines our school.”

The study has implications beyond the emergency room and operating room, Dean Green said. “By establishing a more definitive understanding of the optimal topical anesthesia for pediatric patients, healthcare providers can prevent pain and deliver more tailored and effective pain management strategies in all settings and for patients of all ages.”

Photo credit: CUNY.

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