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Use of Biomarkers to Objectively Evaluate Pain in Critically Ill Children: A Scoping Review
Eleni Tamvaki1, Margarita Giannakopoulou2, Evangelos Bozas3
1Eleni Tamvaki is a registered nurse in pediatric intensive care and a clinical researcher in inherited and rare diseases, Great Ormond Street Hospital for Children, London, England.
Insights
Researchers identified endogenous biomarkers in saliva, blood, and other fluids that correlate with pain in children. Further studies are needed to confirm their use for objective pain assessment in critically ill youth.
Area of Science:
- Biomedical Science
- Pediatric Critical Care
- Pain Management
Background:
- Objective pain evaluation in children is challenging.
- Recent research focuses on identifying reliable pain biomarkers.
- Endogenous biomarkers offer potential for objective pain assessment.
Purpose of the Study:
- To synthesize and critically analyze studies on endogenous biomarkers and pain.
- To identify suitable biomarkers for objective pain evaluation in critically ill children.
Main Methods:
- Systematic literature search of PubMed, Scopus, and Ovid.
- Quality assessment using critical appraisal tools and STROBE checklist.
- Coding of articles for methods and findings.
Main Results:
- Biomarkers were detected in saliva, blood, cerebrospinal fluid, and gingival crevicular fluid.
- Cytokines, peptides, and hormones showed associations with pain, stress, and inflammation.
- Most studies (64%) utilized enzyme-linked immunosorbent assays.
Conclusions:
- Various easily obtainable biomarkers are associated with pain in children.
- Further observational studies are recommended for pain assessment in critically ill children.
- Biomarkers show promise for objective pain evaluation in pediatric critical care settings.
Background:
Many studies have been conducted recently to identify biomarkers that could potentially be used to objectively evaluate pain.
Objective:
To synthesize and critically analyze primary studies of endogenous biomarkers and their associations with pain to identify suitable biomarkers for the objective evaluation of pain in critically ill children.
Methods:
PubMed, Scopus, and Ovid databases were searched; searches were restricted by publication date, language, species, and participant age. Critical appraisal tools and the Strengthening the Reporting of Observational Studies in Epidemiology checklist were used to evaluate quality of evidence.
Results:
All included articles were coded according to methods and findings. Saliva, blood, cerebrospinal fluid, and gingival crevicular fluid were used to detect biomarkers. Enzyme-linked immunosorbent assays were used in most studies (64%). Appropriate statistical analyses were performed at a significance level of P < .05 in included studies. Cytokines, peptides, and hormones were associated with pain, stress, and inflammatory response, suggesting that they can be used to screen for pain in children during painful conditions. Only 1 study in neonates did not show any correlation between saliva biomarkers and pain.
Conclusion:
According to this literature review, various biomarkers that are easily obtained and measured in a clinical setting are associated with pain in children. Further investigation of these biomarkers through observational studies is suggested to evaluate their suitability for pain assessment in critically ill children.
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