Modified Behavioral Pain Scale Research Articles

Oral and topical analgesia in pediatric electrodiagnostic studies.

Electrodiagnostic examinations, such as nerve conduction studies (NCS) and needle electromyography (EMG), are perceived as painful by children and their parents/guardians. Methods to reduce peri-procedural pain improve compliance and have neurocognitive and neuropsychiatric benefits. This study aimed to assess the efficacy of combined oral and topical analgesics (COTA), oral analgesics (OA), and placebo in reducing pain during NCS/EMG in children. We performed a double-blind, randomized, placebo-controlled trial on children presenting to our neurophysiology lab. Patients were stratified into two age groups (6M-6Y and 7Y-18Y) and randomized into three arms: COTA, OA, and placebo. Pain scores post-NCS/EMG were assessed using the Modified Behavioral Pain Scale (MBPS) and Faces Pain Scale-Revised (FPS-R). One hundred thirteen participants were enrolled. A comparison of participants from both age groups combined revealed no significant differences in guardian FPS-R scores across all arms for NCS and EMG. A significant difference in the distribution of post-NCS FPS-R score severities in children aged 7Y-18Y was noted between OA and placebo (p = .007). EMG was more painful than NCS across all arms (p < .05). In children aged 6M-6Y undergoing at least 10 muscle samplings during EMG, those receiving COTA had significantly lower pain scores (p = .014). This study reveals the complexity of pediatric pain perception during NCS/EMG and highlights that other methods to reduce experienced pain are required. Our findings suggest that procedural characteristics, such as number of muscles sampled, may influence the effectiveness of analgesia and serve as a foundation for future research aimed at optimizing pain management strategies.

Effect of Photobiomodulation Therapy With an 810-nm Diode Laser on Pain Perception Associated With Dental Injections in Children: A Double-Blind Randomized Controlled Clinical Trial.

Introduction: This study investigated the photobiomodulation effect of an 810-nm diode laser in adjunction with topical anesthesia on pain perception during infiltration anesthesia of primary maxillary molars in children. Methods: This double-blind randomized controlled clinical trial was conducted on 64 children (aged 5-9 years) requiring extraction or stainless steel crown for their primary maxillary molars. The patients were randomly allocated into two groups (n=32) of laser and control. In the laser group, the injection site (buccal and palatal mucosa) was irradiated with an 810-nm laser (200 mW, 5.2 J/cm2) after 20% benzocaine topical anesthetic application, while the control group received a placebo laser following topical anesthesia. The pain intensity experienced by children during needle insertion into the buccal and palatal mucosa was determined using a visual analog scale (VAS) and modified behavioral pain scale (MBPS). Results: According to the results of the VAS and MBPS, no significant difference was detected in pain scores between the laser and control groups neither in the buccal nor in the palatal mucosa (P>0.05). Conclusion: Photobiomodulation therapy with an 810-nm laser with the current setting adjunct to topical anesthesia did not promote significant additional effects on the pain intensity.

Distraction With Virtual Reality Goggles in Paediatric Dental Treatment: A Randomised Controlled Trial

AimThe aim of this study was to examine whether screening content through virtual reality (VR) goggles can diminish pain perception during local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in routine paediatric dental treatment. Materials and methodsThis is a crossover study of healthy 4- to 12-year-old children who were scheduled to receive local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in 2 visits. The participants were randomly assigned to undergo 1 treatment performed with Oculus GO VR goggles and the other treatment without. Pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Modified Behavioral Pain Scale (MBPS). ResultsThe study group included 29 children with a mean age of 8.29 years (SD, 1.96). Whilst administering local anaesthesia, no significant difference was observed in the Wong-Baker FACES Pain Rating Scale and in MBPS movements between visits with and without the VR goggles. However, significantly lower pain perception was observed in the other parameters of MBPS when using the VR goggles: Face (P = .007) and Cry (P = .046). During placement of a rubber dam, significantly less pain was reported by the patients (P = .005) and observed by the assessor (Face [P = .005], Cry [P = .029], and Movement [P = 0.028]) when the VR goggles were used. ConclusionsVR can decrease pain perception during rubber dam placement in children, but it has limited benefit during administration of local anaesthesia.

The Effect of Breastfeeding Versus Sensorial Saturation on Infants' Behavioral Responses of Pain following Pentavalent Vaccination on 4 and 6 Month Old Infants: A Randomized Controlled Clinical Trial Study.

ABSTRACTBackground: Pain is the fifth vital sign and its proper management in infants is important. The aim of this study was to compare the effect of breastfeeding versus sensorial saturation on infants’ behavioral responses of pain following Pentavalent vaccination on 4 and 6-month old babies.Methods: This single blind randomized controlled clinical trial study was conducted on Shahid Dastgheib Health center in Yasuj, from May to September 2016. Eligible infants (N=180) were selected using convenience sampling method. Then, using block randomization method, we assigned the participants to one of the three groups of Breastfeeding (N=60), Sensorial saturation (N=60), and Control (N=60). The infants’ behavioral responses of pain were measured using the Modified Behavioral Pain Scale (MBPS) and duration of crying following Pentavalent vaccination. Data were analyzed through SPSS software 22 using Chi square, Analysis of Variance (ANOVA), Kruskal-Wallis, and Dunn ’s multiple comparison tests. P<0.05 was considered statistically significant.Results: The results of the study showed that the MBPS mean scores for breast feeding, sensorial saturation, and control groups in 4-month old infants were 6.60±1.60, 5.40±1.30 and 8.90±0.40, and those of 6-month old ones were 7.20±1.10, 6.10±0.90 and 9±0.50, respectively. Also, both the breastfeeding and the sensorial saturation groups scored significantly lower in behavioral responses of pain and crying duration on both 4 and 6-month old infants compared to the control group (P<0.05). Sensorial saturation group significantly scored lower in behavioral responses of pain and crying duration on 4 and 6 month old infants than the breastfeeding group (P<0.05).Conclusion: Both breastfeeding and sensorial saturation could diminish the infants’ behavioral responses of pain following Pentavalent vaccination; however, sensorial saturation was more effective than breastfeeding.Trail Registration Number: IRCT2016051527916N1

Effect of Vibratory Therapy in Decreasing the Vaccination-induced Pain in Infants: Randomized Controlled Study

Background: Different non-medical therapies such as Non-nutritive sucking (NNS), oral sucrose with or without NNS (non-nutritive sucking), wrapping with thin blanket or cloth, kangaroo mother care (KMC), songs as well as multi-sensory stimulation are beneficial in pain reduction among neonates and infants. According to the gate control theory, vibrations applied sat a site on the body block the nociceptive signals via the A???? and C fibers reducing the pain perception. When used along with many other nonpharmacological methods, This technique has been shown to minimize discomfort in pain-inducing treatments such as Intravenous cannulation, vaccines, heel prick, etc. The primary purpose of this study is to analyze vibrational therapy effects on infants pain perception, thereby, providing evidence for a better pain management strategy in vaccination centers.&#x0D; Objective: To determine the efficacy of vibration therapy on pain perception by infants during vaccine administration.&#x0D; Material and Methods: Out of total 90 eligible healthy infants who come for routinely immunization will be given either vibrational therapy (interventional group) or breastfeeding(control therapy) after doing randomization in this randomized controlled trial. The baseline vitals include cardiac rate (HR), respiratory rate (RR), and oxygen (SpO2) will be recorded before, during, and after vaccination during this treatment. Similarly, we will report Visual analog scales (VAS), Neonatal Infant Pain Scale (NIPS), and Wong-Baker FACES Pain Rating Scale, Modified Behavioral Pain Scale (MBPS) after giving the vaccine to the infant.&#x0D; Results: After completion of the study we will come to know the effect of vibratory therapy on pain control. The pain intensity with the help of the NIPS score will get less in the vibratory group than in the control group. The level of distress by using the Color Analogue Scale, MBPS scale, and FLACC scale, during the vaccine-related procedure will get a lower score in the infants who has taken vibratory therapy than the control group.&#x0D; Conclusion: study will probably give us information about vibration therapy, which will be an effective method for managing the pain after vaccination in infants.

Comparison of the Psychometric Properties of the FLACC Scale, the MBPS and the Observer Applied Visual Analogue Scale Used to Assess Procedural Pain.

PurposeThe purpose of this study was to compare the psychometric data and feasibility and clinical utility of the Face Legs, Activity, Cry and Consolability scale (FLACC), the Modified Behavioral Pain Scale (MBPS) and the Visual Analogue Scale for observers (VASobs) used to assess procedural pain in infants and young children.Patients and MethodsTwenty-six clinicians assessed videorecorded segments of 100 infants and young children who underwent a painful and/or distressing procedure in the emergency department using the FLACC scale, the MBPS and the VASobs pain and VASobs distress.ResultsVASobs pain scores were lowest across all procedures and phases of procedures (p < 0.001). Inter-rater reliability was lowest for VASobs pain scores (ICC 0.55). Sensitivity and specificity were highest for FLACC scores (94.9% and 72.5%, respectively) at the lowest cut-off score (pain score two). Observers changed their MBPS scores more often than they changed FLACC or VASobs scores, but FLACC scores were more often incomplete. Reviewers did not consider any scale of use for procedural pain measurement.ConclusionThe reliability and sensitivity of the FLACC and MBPS were supported by study data but concerns about the capacity of these scales to distinguish between pain- and non-pain-related distress were raised. The VASobs cannot be recommended. Despite its limitations, the FLACC scale may be better suited than other scales for procedural pain measurement.

The effect of Aromatherapy Parent Education in Alleviating Injection Pain Among Children Submitting to Vaccination

Background: Aromatherapy parents’ education about pain alleviation during child vaccinations supports family-centered care and has the potency to progress pain care management in children. Aim of the study: evaluate the effect of aromatherapy parent education intervention (massage with lavender oil) in alleviating injection pain among children submitting to vaccination. Subject and methods: Quasi experimental design two groups have been utilized in this study at vaccination clinics in El-Demerdash health office affiliated to Abbasis zone and Elkhalij Elmasry primary health center in Hadayek Elkobba Zone, governmental medical centers, Ministry of Health and Population, Cairo, Egypt. It included 120 children Submitting to Vaccination selected by purposive sampling technique according to inclusion criteria, and randomly designate into two groups; register either in control (60) or study (60) group. The data was collected by using 1) Structured interviews questionnaire in Arabic to assess personal data characteristic of children and parent; 2) knowledge assessment tool (pre/post) to assess parent’s knowledge regarding aromatherapy treatment and pain management after children vaccination;3) beliefs and attitudes of parent assessment tool;4) procedural pain assessment tools which included two parts, the first portion was Modified Behavioral Pain Scale (MBPS) , developed by (Taddio et al, 1995)and the second portion was Cry duration in seconds. The data was collected between a period of august 2019 and January 2020. Results: A significant improvement was in total knowledge about aroma treatment and pain management after vaccination among children’s parent in posttest as compared to pretest assessment (p < 0.0001). A significant improvement was in total mean scores of MBPS components in study group with lavender oil massage during five minutes after vaccine injection as compared to control group with highly statistically significant (p < 0. 001). A significant improvement was in the total mean cry duration in study group as compared to control group with highly statistically significant (p < 0. 001). Conclusion: Aromatherapy parents’ education, leg massage by lavender oil was found efficient in alleviating vaccine injection pain. Recommendation: Applying Aromatherapy Education programs for new parents in all pediatric primary health care centers to increase parents’ awareness about vaccine injection pain alleviation.

Effect of Lavender Oil Inhalation on Injection Pain Intensity Among Children Undergoing Vaccination

Background: Pain control and management are the most critical aspects of basic needs, human rights, and nursing care in children. Aim: to evaluate the effect of lavender oil inhalation on injection pain intensity among children undergoing vaccination Design: A quasi experimental research design was utilized to fit the aim of the study. Setting : the study was conducted in selected governmental, ministry of health and population pediatric primary health centers (health offices). Sample: A purposive sample of 100 child, who attended primary health care centers to receive vaccination injections were enrolled either in control (50) or intervention (50) group randomly. Data collection tools: 1) Structured interview questionnaire, related to the personal characteristics of vaccinated children and nurses who give the vaccine; 2) The Modified Behavioral Pain Scale (MBPS) developed by Taddio et al. (1995). 3) cry duration measured in seconds. Results: There was a highly significant difference between the total pain scores and cry duration of control and intervention group immediately and five minutes after injection with p.≤ 0.05. There was a highly significant positive correlation between total scores of MBPS immediately and five minutes after injection with cry duration in control group. While there was a highly significant correlation between total scores of MBPS five minutes after injection and cry duration in intervention group (P ≤ 0.001). Conclusion: children who were in the intervention group and received lavender oil inhalation after the injection showed lower pain scores using the MBPS scale and shorter cry duration after vaccination injection than those who were in the control group. Recommendation : pediatric nurses need to conduct more strict experimental randomized trials on larger representative samples to evaluate effect of lavender oil inhalation on injection pain reduction among children. Keywords: pain, vaccination, children, pediatric nurses, lavender oil inhalation DOI: 10.7176/JHMN/73-08 Publication date: April 30 th 2020

Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial

ObjectiveNitrous oxide 70% (N2O 70%) is an excellent medication for procedural analgosedation (PAS), yet the limit of its analgesic power remains uncertain; therefore, a combination with intranasal fentanyl (INF) was...

Factors Associated With Infant Pain Severity Undergoing Immunization Injections

PurposeFactors influencing infants' behavioral and vocal (cry) response to painful stimuli are explored to improve pain management plans for infants undergoing immunizations. Design and MethodsAn observational study design was used. Pain responses of 60 to 75 days-old infants (44% male vs 56% female) undergoing two-month immunization injections were videotaped and coded using the Modified Behavioral Pain Scale (MBPS), and duration of total crying time during injection was recorded. The influences of five factors (gender, caregiver attendance, previous experience of nociception (circumcision), mode of delivery), and weight (birth and current) were examined at baseline, during and post-immunization. ResultsHigher birth weight was the most significant factor that reduced pain responses during (p = 0.001) and post-immunization (p = 0.03). A higher birth weight reduced full lung crying (p = 0.04), which reflects crying during injection as compared to total crying time. Vaginal delivery had a significant effect on behavioral pain responses of infants only post-immunization (p = 0.006). Parent's presence in the immunization room significantly reduced total crying time (p = 0.03). Uncircumcised male infants had a significant reduction in behavioral pain responses during immunization (p = 0.01) compared to circumcised infants. ConclusionsThe literature well supports the acknowledgement of early pain experience and its psychological consequences. Knowing and controlling for each of mentioned factors early in life during every painful procedure could improve coping mechanisms of infants for any painful procedures later in life. Practice ImplicationsControl of certain factors during early life experiences can modify pain of immunization.

The Psychometric Properties of the MBPS Scale Used to Assess Procedural Pain

The Modified Behavioral Pain Scale (MBPS) was designed to assess procedural pain in infants and is considered valid for assessing immunization pain. The aim of this study was to assess the practical and psychometric properties of the MBPS when applied to other commonly performed procedures. Twenty-six clinicians independently applied the MBPS scale to segments of video collected from 100 infants and children aged 6 to 42 months undergoing 1 of 4 procedures in the emergency department. Positive correlation between MBPS and Visual Analogue Scale observer applied (VASobs) pain (r = .74) was shown and inter- and intrarater reliability coefficients were high (.87 and .89, respectively). Construct validity was shown by scale responsiveness to painful stimuli (4.6 times increase in scores across phases) and the capacity of the scale to distinguish between painful versus nonpainful procedures (P < .001). However, mean baseline scores for procedures were not 0 (likely a function of item descriptors for a “0” score) and the mean difference increased across phases for children with baseline scores >3, which was much lower than for children with scores <3 (P = .0001). Finally, 28% of scores changed after the second viewing of a video segment. The MBPS appears reliable and sensitive to procedural pain when applied by clinicians. Results question the capacity of the scale to differentiate between pain- and nonpain-related distress, the feasibility of this scale, and the appropriateness of item descriptors for medical procedures. PerspectiveThis article presents the psychometric and practical properties of the MBPS applied to assess procedural pain. Identification of a suitable scale for this purpose will support improved pain management in infants and young children who undergo painful procedures.

Procedural Pain Scale Evaluation (PROPoSE) study: protocol for an evaluation of the psychometric properties of behavioural pain scales for the assessment of procedural pain in infants and children aged 6–42 months

IntroductionInfants and children are frequently exposed to painful medical procedures such as immunisation, blood sampling and intravenous access. Over 40 scales for pain assessment are available, many designed for neonatal...

Vaccination Related Pain: Comparison of Two Injection Techniques.

To compare the acute pain response during immunization in infants using a slow "standard" injection technique vs. "pragmatic" technique. In this randomised controlled trial, source of data were 200 healthy infants of age group 6 wk to one and half years, receiving routine intramuscular vaccination. They were divided randomly using computer generated random numbers into 'Standard group' receiving immunization using standard slow technique with aspiration and 'Pragmatic group' receiving immunization using "pragmatic" technique without aspiration. The entire vaccination procedure was videotaped. Videos were scored for pain using modified behavioral pain scale (MBPS) by 2 clinical psychologists and the mean score was considered for analysis. Pain was scored within 15s of the immunization, were measured and described the child's maximal pain response to the injection. Cry time was measured by a different person from the start of cry till it ends. Entire data was entered in a preformed proforma. The Z test for two sample population means was used for statistical analysis. Standard technique of vaccination needs longer time to administer (5-10s) when compared to pragmatic technique (1-2s). Mean post vaccination MBPS in standard group was 8.4 (SD - 0.75) and in pragmatic group was 7.8 (SD - 1.17) which was statistically significant (p - 0.00). Mean crying duration in pragmatic group was less (32.1s) than standard group (37.37s). The "standard" slow technique was significantly more painful and took longer to administer than the "pragmatic" rapid technique. Cry duration is lesser in pragmaticgroup than standard group, but it is statistically not significant.

A Randomized-controlled Trial of Parent-led Tactile Stimulation to Reduce Pain During Infant Immunization Injections

To determine the effectiveness of parent-led tactile stimulation for pain reduction when added to a combination of evidence-based pain-reducing interventions in infants undergoing immunization injections. Healthy infants aged 4 to 6 months undergoing routine immunization at a primary care practice were eligible. Infants were randomized to tactile stimulation by a parent or usual care. Parents in the tactile stimulation group rubbed the ipsilateral thigh distal to the site for 15 seconds before, during, and after injections. In addition, all infants received evidence-based pain-relieving interventions including: sucrose solution, holding by a parent, and intramuscular injection without aspiration. The primary outcome was pain, measured by a validated tool, the Modified Behavioral Pain Scale (MBPS), by an observer unaware of treatment allocation using videotapes of the procedure. MBPS scores could range from 0 (no pain) to 10 (maximum pain). Parents, unaware of the study hypothesis, also rated infant pain in real time using a 100 mm visual analogue scale. One hundred twenty infants participated. Infant characteristics did not differ (P>0.05) between the tactile stimulation and control groups. Mean MBPS scores and parent visual analogue scale scores did not differ between groups (8.2 [1.1] vs. 8.0 [1.3]; P=0.57) and (60 [20] vs. 53 [22] mm; P=0.10), respectively. Parent-led tactile stimulation did not reduce pain in infants undergoing immunization injections when combined with other pain-relieving interventions. Potential reasons for the lack of effectiveness are discussed. Investigation of the effectiveness of clinician-led tactile stimulation in this population is recommended.

EMLA® cream: A pain-relieving strategy for childhood vaccination

To evaluate the effectiveness of topical eutectic mixture of local anaesthetics (EMLA®) cream in reducing the pain associated with vaccination injections. This was a randomized, double-blind, placebo-controlled study that included children who presented for routine immunization. Eligible children were randomly assigned to receive either EMLA® or placebo cream. The Modified Behavioural Pain Scale (MBPS) was used to assess baseline and postvaccination pain scores, while a visual analogue scale (VAS) was used to assess pain at the time of the needle prick and at the end of the injection. A total of 107 children were enrolled in the EMLA® group and 109 children in the placebo group. The difference between the pre- and postvaccination MBPS scores was significantly lower in the EMLA group than in the placebo group (2.56 ± 1.96 versus 3.95 ± 2.20, respectively). The VAS scores at the time of the needle prick and after the injection were significantly lower in the EMLA® group compared with the placebo group (1.60 ± 1.67 versus 3.24 ± 2.01; 3.29 ± 2.27 versus 4.86 ± 2.20; respectively). Application of EMLA® cream can be effectively incorporated as a routine pain-relieving intervention within routine vaccination appointments.

2360 – Infants’ vaccination pain management and effect of breast feeding, sucking the pacifier and mother's hug: a randomized control trial

Infants’ vaccination pain management by using lowest side effect methods is very important. The aim of this study was to examine pain relieving effect of breast- feeding, sucking pacifier or being in mother's hug during DPT vaccination. This controlled trial study, was performed on 152) healthy2- 4 months term infants, whom was brought to the health centers of west of Tehran for DPT vaccination and their parents filled in informed consent. (Year 2008–2010) By randomized collection infants divided to three intervention group (Breast feeding, Sucking pacifier and being in mothers hug, and each group had intervention 2 minutes before, during, and 15 seconds after the injection) and control group, whom lied on the examining bed as routine of clinics (38 in each group). Objective changes in appearance of Neonates were assessed by Modified Behavioral Pain Scale (MBPS) during 5 second before immunization to 15 second after it. Descriptive and inferential statistics were used. All ethical points were considered and approved by Research ethics committee of TUMS and had registered in Iranian Registry of Clinical Trials (IRCT). Equality of age, gender and the time of feeding prior to vaccination were controlled. There were significant differences in Behavioral Pain Scores of four groups. (P < 0.0001) and routine group had highest pain score. Breast feeding is more analgesic than pacifier use with maternal holding. Maternal holding had less effect, but had more significant effect than routine. It is suggested to use these simple interventions during infant's vaccination.

P-911 - Effect of breast feeding on infant's behavioral pain scale during DPT vaccination

Pain management is the challenging concepts in neonatal care. Since Neonates have higher pain sensitivity in comparison of childhood and adults, pain management has become crucial part of neonatal care and cure. To examine the pain relieving effect of breast feeding during DPT immunization injections in healthy neonates. 76 healthy 2– 4 months years old term infants, which had been brought to the health centers of Tehran University of Medical Sciences in West of Tehran for DPT vaccination by their mothers was involved in this randomized controlled trial study. (Their parents signed informed consent, Year 2008–2009) By randomized collection one group were breast-fed, 2 minutes before, during, and 15 seconds after the DPT immunization injection, and second group according to routine of clinic lied on the examining table during DPT Vaccination. Objective changes in appearance of Neonates were assessed by Modified Behavioral Pain Scale (MBPS) during 5 second before immunization till 15 second after it. The equality between two groups according to age, gender and the time of feeding prior to vaccination were checked, there weren’t correlation. There were significant differences in Behavioral Pain Scores of two groups in all parts include: facial expression (4 items), cry (5 items), and movements (6 items). (P < 0.0001) Regarding to significant difference in behavioral of Pain responds in two groups, it is suggested that, with simple and safe intervention of straight breast feeding, health care workers, and physicians reduce pain during immunization and muscular injections too.

A double-blind randomised controlled trial of 25% oral glucose for pain relief in 2-month old infants undergoing immunisation

BackgroundInfant immunisation is the most commonly performed health procedure in developed countries. Associated pain may be harmful because we do not know what painful experiences the infant has already had and whether it might contribute to a cumulative pain experience. Healthy infants undergo immunisation with minimal pain relief. However, immunisation pain can be managed using oral sweet solutions. ObjectiveTo determine the effectiveness of 25% oral glucose solution in reducing immunisation pain in 2-month old infants. Trial design and methodsA double-blind, randomised controlled trial conducted in Jordan. A total of 120 healthy full-term infants who met the eligibility criteria and were attending immunisation clinics for routine 2-month immunisation were randomised to receive either 2mL of 25% oral glucose solution immediately prior to their immunisation or 2mL of oral sterile water. Researchers, nurses and parents were blind to the solution. Primary outcome was behavioural pain measured using the Modified Behavioural Pain Scale (MBPS). Secondary outcomes were crying time and duration of full-lung cry. Crying was registered from onset of the immunisation injection and for up to 120s after completion of the injection procedure. ResultsInfants in the intervention group experienced statistically and clinically significant reduction in behavioural pain responses (p<0.001), and spent less time crying up to 2min after the procedure (mean difference 38 vs. 77.9s). ConclusionA 2mL oral dose of 25% glucose given immediately before an immunisation procedure reduces pain in 2-month old infants.

Evaluation of the reliability, validity and practicality of 3 measures of acute pain in infants undergoing immunization injections

There is a need to identify a primary measure of infant pain that can be used to assess pain in infants undergoing vaccine injections in order to facilitate vaccine outcomes research. The aim of the present study was to determine the reliability, validity and practicality of 3 measures of acute pain in infants; the Modified Behavioural Pain Scale (MBPS), Neonatal Infant Pain Scale (NIPS), and Face Legs Activity Cry Consolability Scale (FLACC). Five raters rated pain from videotapes in 120 infants aged 2–6 months undergoing vaccine injections that participated in a randomized controlled trial designed to compare pain responses between two vaccines, DPTaP-Hib vaccine and PCV vaccine. Inter-rater reliability coefficients for baseline and vaccine injections were all greater than 0.85. Cronbach's alpha ranged from 0.83 to 0.94. Construct validity was demonstrated for all measures by vaccine injection scores that were higher (p<0.001) than baseline scores and by PCV scores that were higher than DPTaP-Hib scores. Concurrent validity was demonstrated by bi-variate correlation coefficients that ranged from 0.84 to 0.92. Intra-rater reliability coefficients for scores obtained after a single viewing (simulating real time assessment) versus multiple viewings were ≥0.96. All measures demonstrated a significant difference in pain scores between the more painful (PCV) and less painful (DPTaP-Hib) vaccine for scores obtained after a single viewing. The majority of raters (4 out of 5) preferred the MBPS. Together, these results provide preliminary support for the MBPS as the primary outcome of pain during vaccine injections in infants.

1363 Empirical Mode Decomposition to Assess Coupling Between Infants Cry Signals and Pain Expression Quantified by a Pain Score

Introduction: Coupling between fundamental frequency variation and intensity contour during crying reflects the degree of maturation of the central nervous system. We recently described the use of Empirical Mode Decomposition (EMD) to quantify coupling during infant cries [1]. We subsequently wanted to evaluate if there is an association between the extent of (de)coupling and quantitative pain expression.Methods: To assess decoupling during crying in healthy term neonates during procedural pain, 47 newborns were videotaped and crying was recorded during venous blood sampling [2]. Acoustic analysis was performed and coupling between pitch frequency and the amplitude (energy) of the cry while pain expression was quantified based on the Modified Behavioral Pain Scale (MBPS). The relation between acoustic properties and the MBPS were explored.Results: The correlation between pitch frequency and amplitude of the cry was strong (0.69±0.1, range 0.41-0.83). On the other hand, the correlation between the coupling of the cry sounds and MBPS shows positive trend (r=0.38, p = 0.008).Conclusions: This study shows that pitch frequency and amplitude in neonates are significantly coupled, as it has already been reported, but not quantified. In addition, the acoustic properties of the neonates' cry signal relate to the MBPS. Although significant, this correlation only to a limited extent explains the interindividual variability in coupling observed.