The upcoming release of the It remake this September spells doom for the rapidly declining reputation of clowns. History has never been totally kind to these powder-faced jokers, but their public image took a hit in 2016 after Jared Leto appeared in Suicide Squad, which may or may not have led to a rash of clown-faced trolls getting arrested across the United States. Will clowns be pegged as weird bad guys forever?

Not if a team of Israeli children’s doctors have their say.

It turns out that clowns have an unexpectedly analgesic effect on physical pain, at least in kids receiving treatment for cerebral palsy, as their recent study in PLoS One showed. In the paper, published in April, the researchers showed that “clown-care” can help numb the pain caused by injections, which are used frequently in cerebral palsy treatment.

“Most children receiving clown-care reported lower pain levels similar to other clown studies, which is the goal of behavioral and cognitive interventions,” the researchers wrote, noting that kids that didn’t get clown care experienced a level of pain that was unexpectedly high.

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Medical clowning was used to help ease the pain of cerebral palsy treatment in kids.

The 45 kids with cerebral palsy made an ideal study group because their treatment exposes them to so many injections, which cause them physical pain as well as anxiety. The standard treatment is to give them injections of botulinum toxin, which makes it easier for them to control their muscles; unfortunately, multiple and recurrent doses are required. Normally, if kids are really distressed about needles, doctors give them light sedatives, like midazolam or nitrous oxide (incidentally, a common clown tool). But some physicians would rather not give kids drugs and anaesthetics unless they really have to. One good non-pharmacological option? Clowns.

“Medical clowning,” in this case, consisted of having professional clowns interact with the kids before, during, and after they received their injections. These clowns employed several techniques to encourage the kids, depending on their age, and sometimes, they’d repeat positive thoughts (“You are stronger than the needle!”) and guiding their imaginations (“You’re the captain on a ship!”); other times, they’d let the kids control their actions like a puppet, or act out the kids’ emotions in an exaggerated way. Before the injections, the kids were asked how much pain they thought they would feel; afterward, they were asked how much pain they’d actually experienced.

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Never a frown when clowns are around.

For kids getting a needle for the first time, starting treatment in the presence of a clown made a big difference: These kids felt less pain, even during later procedures that didn’t involve clowns. But more broadly, kids who got their injections in the presence of a clown felt less pain than they anticipated compared to the kids who didn’t — this latter group actually felt more pain than expected.

This bodes well for kids who are often subjected to painful treatments, especially in light of the fact that doctors “are not always cognizant of the pain and trauma experienced by children when undergoing interventions,” as the researchers point out. Doctors, they note, have a tendency to dismiss the kids’ concerns about pain because they’re more concerned with medical risks. However, it’s important that the kids aren’t traumatized by these early experiences so that they’ll cooperate in future medical interventions. That, the researchers conclude, is how clowns can help.

What they don’t address, however, is what happens when the thing that traumatizes the kid isn’t the needle but the clown? It seems that this was not the case in this study — perhaps clown stigma is not as great in Israeli society — but there’s no question it’d give some parents pause stateside. Psychological research has shown that the ambiguity of a clown face tends to trigger a state of heightened alert in the brain, which translates into anxiety. Perhaps, given the right kind of clown, those fears can be allayed — and the reputation of clowns rescued from its near-inevitable demise.

Photos via Ben-Pazi et al/PLoS One, Ben-Pazi et al./PLoS One