Slater, R;
Cantarella, A;
Franck, L;
Meek, J;
Fitzgerald, M;
(2008)
How well do clinical pain assessment tools reflect pain in infants?
PLOS MED
, 5
(6)
, Article e129. 10.1371/journal.pmed.0050129.
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Abstract
BackgroundPain in infancy is poorly understood, and medical staff often have difficulty assessing whether an infant is in pain. Current pain assessment tools rely on behavioural and physiological measures, such as change in facial expression, which may not accurately reflect pain experience. Our ability to measure cortical pain responses in young infants gives us the first opportunity to evaluate pain assessment tools with respect to the sensory input and establish whether the resultant pain scores reflect cortical pain processing.Methods and FindingsCortical haemodynamic activity was measured in infants, aged 25-43 wk postmenstrual, using near-infrared spectroscopy following a clinically required heel lance and compared to the magnitude of the premature infant pain profile (PIPP) score in the same infant to the same stimulus (n = 12, 33 test occasions). Overall, there was good correlation between the PIPP score and the level of cortical activity (regression coefficient = 0.72, 95% confidence interval [CI] limits 0.32-1.11, p = 0.001; correlation coefficient 0.57). Of the different PIPP components, facial expression correlated best with cortical activity ( regression coefficient = 1.26, 95% CI limits 0.84-1.67, p < 0.0001; correlation coefficient 0.74) (n = 12, 33 test occasions). Cortical pain responses were still recorded in some infants who did not display a change in facial expression.ConclusionsWhile painful stimulation generally evokes parallel cortical and behavioural responses in infants, pain may be processed at the cortical level without producing detectable behavioural changes. As a result, an infant with a low pain score based on behavioural assessment tools alone may not be pain free.
| Type: | Article |
|---|---|
| Title: | How well do clinical pain assessment tools reflect pain in infants? |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1371/journal.pmed.0050129 |
| Publisher version: | http://dx.doi.org/10.1371/journal.pmed.0050129 |
| Language: | English |
| Additional information: | © 2008 Slater et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This study was funded by The Wellcome Trust, The Medical Research Council, and SPARKS. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. |
| Keywords: | EXPRESSION, RESPONSES |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > Div of Biosciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > Div of Biosciences > Neuro, Physiology and Pharmacology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Neonatology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/176378 |
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