Abstract
Evaluation of comfort and pain in neonates is important for management. Specific signs of persistent pain in neonates remain undefined; few validated clinical tools assess persistent pain. We sought to determine (i) difficulty perceived by staff and parents in assessing comfort/persistent pain in babies, (ii) strategies employed when no clinical tool is used and (iii) variation between clinicians' assessments. Parent and staff questionnaires addressed difficulty in assessing pain/comfort in neonates and strategies used in making assessments. A total of 47 of 50 (94%) parents and 83 of 91 (91%) staff participated; 50% of staff reported it was moderately/very difficult to assess persistent pain, and 13% very easy; 75% of parents found it moderately/very easy and 23% difficult to assess their baby's comfort; 15% of parents thought staff found pain assessment difficult. Staff described 94 different factors indicative of comfort and 139 factors of persistent pain. Terminology differed widely and was often nonspecific; 67% of staff described forming a 'general impression'. Pain assessment is challenging for staff. Most parents feel confident in assessing their babies' comfort, but may overestimate the ease with which staff can do so. Indicators of persistent pain/comfort are poorly defined; staff use differing, subjective assessments, which may complicate communication between carers.
Highlights
Pain assessment is an important part of care in the neonatal intensive care unit (NICU), and can help to achieve appropriate and timely pain management
All participating staff rated the management of persistent pain as a very important part of neonatal care. 50% of staff reported that it was either moderately difficult or very difficult for them to determine whether a baby was comfortable or had persistent pain; only 13% reported that they found it very easy
All parents who returned questionnaires reported that they regarded the management of persistent pain as a very important part of their baby’s care. 75% of parents indicated that they found it either very easy or moderately easy to determine whether their own baby was comfortable; 23% said it was difficult for them
Summary
Pain assessment is an important part of care in the neonatal intensive care unit (NICU), and can help to achieve appropriate and timely pain management. Simple environmental measures such as containment or facilitated tuck are useful in managing pain in a newborn baby. It has been suggested that persistent pain in neonates may be considered as that resulting from inflammatory conditions, therapeutic interventions such as mechanical ventilation, or repeated procedures. It has been defined as pain persisting for longer than would normally be expected following a particular painful stimulus[7]. Clear and specific signs of persistent pain in neonates remain undefined, a framework for defining terminology for pain in the newborn has recently been proposed, albeit with a limited evidence base[8]
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