syndromes such as migraine headaches or long-term illnesses Hypnosis has also been recommended for the acute management of burns, fractures, and other injuries; however, its use for painful procedures in a busy ED has not been rigorously evaluated Counterstimulation is a technique by which someone repetitively and persistently rubs or touches an area of the body close to the area that is being hurt This technique is based on the gate theory of pain Transmission of pain information from dorsal horn cells occurs through a “gate,” which opens in response to signals from the affected small fibers The gate can be “closed” by large neurons that are stimulated by nonpainful touching or pressing of the skin The theory explains why we rub our elbow when we hit it against something: The rubbing stimulates these large fibers and suppresses the anticipated painful sensation Preliminary studies demonstrate effectiveness of a quickly pulsating device, along with a cold pack, applied to the skin proximal to a venipuncture site using the “gate theory” in order to provide analgesia Restraint should not be used in lieu of appropriate sedation and analgesics for the pediatric patient Although proper restraint of a child for a painful procedure does not always reduce fear or anxiety, it does allow the physician to perform the task better This indirectly reduces pain because fewer attempts may be necessary to accomplish the task One should never attempt a painful procedure on a moving subject! The need for restraint should be explained to the parents, who should not be involved in the actual process Instead, the child might be wrapped in hospital sheets around the torso and extremities, with the parents attempting to calm the child afterward The wrapping technique should be monitored carefully to avoid the uncommon complications of minor bruising, edema, or transient vascular compromise SPECIAL SITUATIONS The Emotionally Labile Child There are a number of issues the clinician faces when caring for an injured child who is known to be emotionally labile This includes children with autism, developmental delay, behavioral disorders, or an adjustment disorder It is important to assess the child’s expected emotional response in a foreign environment, use the social and emotional support available to the