Clown-care reduces pain in children with cerebral palsy undergoing recurrent botulinum toxin injections-A quasi-randomized controlled crossover study

Objective We investigated the impact of clown-care on pain in 45 children with cerebral palsy who underwent recurrent Botulinum-toxin injections (age 7.04 +/- 4.68 years). Participants were randomized to receive either clown (n = 20) or standard (n = 25) -care. Methods Pain Visual-Analogue-Scale (range 1 - 5) was reported before and after procedures. Pain assessment was lower for children undergoing Botulinum-toxin injections with clown-care (2.89 +/- 1.36) compared to standard-care (3.85 +/- 1.39; p = 0.036) even though pain anticipated prior to procedures was similar (similar to 3). Findings Children who underwent the first procedure with clown-care reported lower pain even after they crossed-over to the following procedure which was standard (p = 0.048). Carryover effect was more prominent in injection-naive children (p = 0.019) and during multiple procedures (p = 0.009). Prior pain experience correlated with pain in subsequent procedures only when first experience was standard-care (p = 0.001). Conclusions Clown-care alleviated pain sensation during Botulinum-toxin injections and initial clown-care experience reduced pain during subsequent injections even though clowns were not present.