Circadian pain assessment in neonates from a nurse's perspective

Circadian rhythms modulate the activity of pain pathways. But there appears to be a lack of understanding of how the perception of pain varies in neonates during the day. To assess circadian variations in pain perception we analyzed intensities of pain at 3 h intervals in neonates (within 24 hours). We also followed up the nursing interventions practiced for pain reduction and their effectivity within a day.

We have analyzed the clinical observations of pain in 16 neonates during 62 days of hospitalization (with Mean = 3.87, Min = 1, Max = 19). The pain was assessed by a modification of the Comfort scale supplemented with Wong-Baker scale. Procedure used for acute pain elimination was administration of 24% sucrose to the neonates. This procedure was centralized and performed in an incubator or neonatal bed.

We confirmed statistically significant difference in pain scores in our group of neonates at 10:00 am, 4:00 pm, 4:00 am as compared to 10:00 pm (p values being 0.02603; 0.02885, 0.01673). The pain score was highest at 10:00 pm (Mean = 18.86, Max = 34) and at 1:00 am (Mean = 18.89, Max = 33). There was no significant difference in the pain score at 10:00 pm and 1:00 am (p = 0.2951).

The results of our studies provided further evidence of circadian rhythm in the pain scores in neonates. A better understanding of circadian control of pain in neonates can help promote a more frequent use of time-contingent pain treatment strategies to help improve neonates care (Tab. 1, Fig. 2, Ref. 28) Keywords: circadian rhythm, neonate, nursing care, pain, the Comfort scale.