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The use and reporting of neonatal pain scales: a systematic review of randomized trials
Emma Olsson1,2, Hanna Ahl3, Kevin Bengtsson4
1Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
Insights
Many studies use neonatal pain scales inappropriately for specific infant conditions or pain types. This review highlights concerns regarding research ethics and resource allocation due to incorrect pain scale selection in trials.
Area of Science:
- Neonatal care
- Clinical research methodology
- Pain assessment
Background:
- Pain management in newborns is critical but its assessment is complex.
- The appropriateness of neonatal pain scale use across different infant conditions and pain types requires thorough investigation.
Purpose of the Study:
- To systematically review and evaluate the reporting and appropriate use of neonatal pain scales in randomized controlled trials.
- To identify trends in pain scale selection and assess their validity for specific neonatal populations and pain types.
Main Methods:
- A comprehensive systematic search was conducted across multiple databases (Embase, PubMed, PsycINFO, CINAHL, Cochrane Library, Scopus, Luxid) up to March 2019.
- Included randomized and quasi-randomized trials reporting on neonatal pain scales.
- Data extraction and quality assessment were performed independently by two researchers.
Main Results:
- 352 trials involving 29,137 infants and 22 pain scales were included.
- Premature Infant Pain Profile (48%) and Neonatal Infant Pain Scale (23%) were most common.
- The Neonatal Infant Pain Scale, validated for acute pain, was also used for ongoing and postoperative pain (21%).
- Pain scales lacked validation for the specific population or pain type in 16% of studies.
- Blinding for pain assessment was reported in only one-third of trials.
Conclusions:
- While six validated pain scales dominate usage, their application is not always appropriate for the specific infant population or pain type.
- Inconsistent and inappropriate use of neonatal pain scales raises significant ethical concerns and questions the efficient use of research resources.
- Emphasizes the need for careful selection of validated pain scales tailored to the specific context of neonatal pain assessment in research.
Abstract:
The burden of pain in newborn infants has been investigated in numerous studies, but little is known about the appropriateness of the use of pain scales according to the specific type of pain or infant condition. This systematic review aimed to evaluate the reporting of neonatal pain scales in randomized trials. A systematic search up to March 2019 was performed in Embase, PubMed, PsycINFO, CINAHL, Cochrane Library, Scopus, and Luxid. Randomized and quasirandomized trials reporting neonatal pain scales were included. Screening of the studies for inclusion, data extraction, and quality assessment was performed independently by 2 researchers. Of 3718 trials found, 352 with 29,137 infants and 22 published pain scales were included. Most studies (92%) concerned procedural pain, where the most frequently used pain scales were the Premature Infant Pain Profile or Premature Infant Pain Profile-Revised (48%), followed by the Neonatal Infant Pain Scale (23%). Although the Neonatal Infant Pain Scale is validated only for acute pain, it was also the second most used scale for ongoing and postoperative pain (21%). Only in a third of the trials, blinding for those performing the pain assessment was described. In 55 studies (16%), pain scales that were used lacked validation for the specific neonatal population or type of pain. Six validated pain scales were used in 90% of all trials, although not always in the correct population or type of pain. Depending on the type of pain and population of infants included in a study, appropriate scales should be selected. The inappropriate use raises serious concerns about research ethics and use of resources.
