Pain-specific Reactions or Indicators of a General Stress Response?

Abstract

Objectives: There are many neonatal pain assessment tools available. However, systematic psychometric comparisons between tools are lacking, particularly those comparing tools regarding their ability to differentiate between pain and stressful procedures. The aim of the present study was to compare 5 widely used neonatal pain assessment tools: Neonatal Facial Coding System-Revised, Premature Infant Pain Profile-Revised, Neonatal Pain, Agitation and Sedation Scale, Neonatal Infant Pain Scale, and Bernese Pain Scale Neonates. Materials and Methods: Two coders applied all pain assessment tools to videos of 42 neonates who were videotaped during a pain and a stressful procedure. Results: Interrater reliability and relative convergent validity were high and internal consistency good to excellent for all 5 assessment tools. All tools discriminated between painful and stressful events. Tools differed regarding their overall effect sizes as well as their items’ effect sizes. Behavioral items tended to have larger effect sizes than physiological ones. Yet, effect sizes of items from one behavioral category differed greatly, which may be due to different operationalization of coding schemes. Discussion: Given that the tools investigated in the present study appear to be fairly comparable psychometrically. Aspects of their clinical utility are discussed and ways of improvement identified.

Neonatal Pain, Agitation, and Sedation Scale’s use, reliability, and validity: a systematic review

“…Inter-rater reliability was reported in three studies [11,21,24] and found to be excellent [45] (ICC = 0.93-0.99). Across the four studies, reliability estimates for using N-PASS to measure acute pain included representation from all gestational age groups (extremely preterm [21], very preterm [21], late preterm [11,21,24], and term infants [21]). Additionally, reliability estimates included mechanically ventilated [11,21], nonmechanically ventilated [21], and postoperative neonates [30].…”

“…N-PASS was used to measure acute (e.g., procedural) pain in all neonatal gestational age categories as defined by WHO, including extremely preterm (n = 5) [17][18][19][20][21], very preterm (n = 5) [17,18,[21][22][23], late preterm (n = 5) [10,11,17,21,24], and term infants (n = 7) [17,21,[25][26][27][28][29]. N-PASS was also used to measure acute pain in infants age 1-36 months (n = 1) [30].…”

“…Four studies reported reliability of N-PASS for assessing acute pain with internal consistency reliability ranging from good to excellent [44] (α = 0.837-0.971) [11,21,24,30]. Inter-rater reliability was reported in three studies [11,21,24] and found to be excellent [45] (ICC = 0.93-0.99).…”

“…Four studies reported reliability of N-PASS for assessing acute pain with internal consistency reliability ranging from good to excellent [44] (α = 0.837-0.971) [11,21,24,30]. Inter-rater reliability was reported in three studies [11,21,24] and found to be excellent [45] (ICC = 0.93-0.99). Across the four studies, reliability estimates for using N-PASS to measure acute pain included representation from all gestational age groups (extremely preterm [21], very preterm [21], late preterm [11,21,24], and term infants [21]).…”

Sensorial saturation improves infants’ procedure-related pain behaviour in the cardiac intensive care unit: A quasi-experimental study

“…1 Possible short-term effects of pain include physiological instability, such as increases or decreases in blood pressure, heart rate, respiratory rate, or haemodynamic stability and oxygenation; 2 long-term consequences include psychological and behavioural disorders, learning disabilities, and negative effects on psychosocial development. 2 Infants in the cardiac intensive care unit (CICU) are often subjected to invasive procedures that cause pain, distress, and anxiety, such as jugular central venous catheter (CVC) removal. 3 Consequently, infants may experience interrupted sleep, agitation, and physiological and behavioural instability, which can also result in negligence or delayed treatment.…”