Validation of the Pain Assessment in Neonates (PAIN) Scale with the Neonatal Infant Pain Scale (NIPS)

Hudson-Barr, Diane; Capper-Michel, Beverly; Lambert, Sally; Palermo, Tonya M.; Morbeto, Kristen; Lombardo, Stephanie

doi:10.1891/0730-0832.21.6.15

Cited by 113 publications

(87 citation statements)

References 15 publications

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“…Although more than 40 scoring schemes and pain evaluation scales have been published in the last two decades [1][2][3] the IASP, as an international authority, recommend only the following scales: 1) Neonatal Infant Pain Scale and Premature Infant Pain Profile (PIPP) for evaluation of acute procedural pain, 2) Crying, Required O2, Increased Vital Signs, Expression, Sleeplessness for evaluation of postoperative pain, 3) Echelle Douleur Incomfort Nouveau-Né for evaluation of permanent, persisting or continuing pain. However, the problem with these scoring schemes apart from PIPP is that they do not distinguish infant gestational age 4 .…”

Section: Introductionmentioning

confidence: 99%

Skin conductance as a marker of pain in infants of different gestational age

Macko¹,

Moravčíková²,

Kantor³

et al. 2014

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Aims. To assess the use of skin conductance as an objective measure of pain in infants of different gestational age. A second aim was to investigate the relationship between skin conductivity and selected physiological and behavioural variables (oxygen saturation, heart rate and behavioural state). Methods. Infants were divided according to gestational age into the following 3 groups; group A: 25+0 -31+6 weeks (13 infants), group B: 32+0 -35+6 weeks (25 infants), group C: 36+0 -41+6 weeks (19 infants). The pain stimulus was blood sampling. Results. The most sensitive parameter for describing changes in skin conductance related to pain was peak per second. No other parameter correlated with the physiological variables chosen. The results showed that the inability to determine basal skin conductance is a crucial disadvantage to practical application. The lack of correlation between conductance parameters and gestational age is surprising. Conclusion. We conclude that the Peak per Second is the best parameter for evaluating skin conductance in infants and it is not influenced by gestational age. Peaks per Second correlate only with Prechtl's Scale of behavioural state and not with the physiological parameters chosen.

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Section: Introductionmentioning

confidence: 99%

Skin conductance as a marker of pain in infants of different gestational age

Macko¹,

Moravčíková²,

Kantor³

et al. 2014

BIOMED PAP

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“…The Neonatal Infant Pain Scale (NIPS; Lawrence et al, 1993), the COMFORT scale (Ambuel et al, 1992, the Premature Infant Pain Assessment (PIPA; Jorgensen et al, 1999), the Pain Assessment Tool (PAT; Spence et al, 2003) and the Distress Scale for Ventilated Newborn Infants (Sparshott, 1996) either have been validated using only older preterm infants (i.e.> 32 weeks), or have not been evaluated for their clinical utility. The PAIN Scale (Hudson-Barr et al, 2002) is an adapted version of the NIPS scale. Although the validity of this scale has been assessed, inter-rater reliability has not been established and little variation exists between basal and stimulus-response scores.…”

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confidence: 99%

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Holsti

Grunau²

2007

Pain

155

117

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Accurate pain assessment in preterm infants in the neonatal intensive care unit (NICU) is complex. Infants who are born at early gestational ages (GA), and who have had greater early pain exposure, have dampened facial responses which may lead to under-treatment. Since behavioral and physiological responses to pain in infants are often dissociated, using multidimensional scales which combine these indicators into a single score may limit our ability to determine the effects of interventions on each system. Our aim was to design a unidimensional scale which would combine the relatively most specific, individual, behavioral indicators for assessing acute pain in this population.The Behavioral Indicators of Infant Pain (BIIP) combines sleep/wake states, 5 facial actions and 2 hand actions. Ninety two infants born between 23-32 weeks GA were assessed during 3, one minute Phases of blood collection. Outcome measures included changes in BIIP and in Neonatal Infant Pain Scale (NIPS) scores coded in real time from continuous bedside video recordings; changes in heart rate (HR) were obtained using custom physiological processing software.Scores on the BIIP changed significantly across Phases of blood collection (p < 0.01). Internal consistency (0.82) and inter-rater reliability (0.80-0.92) were high. Correlations between the BIIP and NIPS were modest (r = 0.64, p < 0.01) as were correlations between the BIIP and mean heart rate (r = 0.45, p < 0.01). In this initial study, the BIIP has been shown to be a reliable, valid scale for assessing acute pain in preterm infants in the NICU. Keywordspremature; infant; pain; assessment IntroductionPreterm infants undergo repeatedly painful diagnostic and therapeutic procedures to ensure their survival. In order to provide appropriate pain management in this population, accurate assessment of pain is necessary (Anand et al., 2005), yet complex because we are limited to indirect measures of pain responses. And although infant pain responses have both behavioralCorresponding author: Dr. Liisa Holsti, Centre for Community Child Health Research, F611, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4. Canada, Phone: 604-875-2000, local 5200, Fax: 604-875-2384, E-mail address: lholsti@cw.bc.ca. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. and physiological components, dissociations between behavioral and physiological pain responses are common (Barr, 1998;Morison et al., 2001). Furthermore, facial actions are the relatively most specific behavioral pain indicators in preterm infants, yet these responses may be dampened. Grunau et al...

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“…Neonates in the NICU often experience painful procedures during routine care, 10,21 such as needle insertions, [46][47][48][49][50][51] suctioning, 47,52,53 gavage-tube placement, 51,52,54 and tape removal, 52 as well as stressful disruptions, including diaper changes, 54 chest physical therapy, 54 physical examinations, 51 nursing evaluations, 52 and exposure to environmental stimuli. 20 Despite increased awareness by caregivers that neonates in the NICU frequently experience pain, effective pain relief for these routine procedures is often underused.…”

Section: Reducing Pain From Bedside Care Proceduresmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

414

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The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

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Validation of the Pain Assessment in Neonates (PAIN) Scale with the Neonatal Infant Pain Scale (NIPS)

Abstract: The scores for individual items on the PAIN were significantly associated with scores obtained on the NIPS. Overall correlation between the scales was 0.93. These associations suggest that the PAIN is a valid scale for assessment of neonatal pain.

Cited by 113 publications

References 15 publications

Skin conductance as a marker of pain in infants of different gestational age

Skin conductance as a marker of pain in infants of different gestational age

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Prevention and Management of Pain in the Neonate: An Update

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