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Neonatal pain should be assessed routinely every 4-6 hours or if clinically indicated using context-specific, validated, and objective pain assessment methods.
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Nonpharmacologic and environmental measures are effective for nonspecific distress or acute procedural pain, or can be used as adjunctive therapies for severe ongoing pain.
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Moderate or severe pain requires local/topical anesthetic agents, acetaminophen, NSAIDs, morphine, fentanyl, ketamine, or dexmedetomidine, singly or in combination to
Pain Management in Newborns
Section snippets
Key points
Pain assessment
Current practice requires the nursing staff to make a global pain assessment of neonates or apply validated pain scoring methods before taking appropriate actions to ameliorate newborn pain or discomfort.24, 28, 29 The current nursing workload in the NICU does not allow bedside nurses to assess neonatal pain accurately. Many pain scales lump together behavioral, physiologic, and other variables; but these variables may not respond to neonatal pain in similar or specific ways. The interrater
Nonpharmacologic Approaches
Nonpharmacologic approaches to pain relief are underappreciated, underutilized, and understudied.56 These methods of pain relief have demonstrated effectiveness in NICU care in certain situations, and modern NICUs should use these methods when appropriate. Although opinions differ on the use of complementary and alternative medicine, up to half of the population of the developed countries use this form of therapy57; 13.7% of the US population seeks advice from alternative therapists and doctors
Implementing pain management in the neonatal intensive care unit: a quality improvement approach
Pain in modern-day NICUs is inadequately treated, despite the overwhelming evidence depicting the adverse consequences of unrelieved pain/stress. Carbajal and colleagues22 found that preterm neonates experienced 10 to 14 painful procedures daily, most of which (80%) were not preceded by specific analgesia. Numerous other NICUs have noted similar findings.235, 236, 237 Even more concerning is the potential that chronic pain may be ignored, especially in mechanically ventilated neonates.238
Summary
Pain management in neonates has made great strides over the last several years. Because of the serious short- and long-term adverse effects of pain and because of humanitarian reasons, all NICU patients deserve a focus on pain prevention, routine pain assessments, and evidence-based strategies for pain management, using both nonpharmacologic and pharmacologic approaches. Because pain strategies continue to fall short, future research should address systems-based practice and knowledge-transfer
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Cited by (176)
Long-term effects of neonatal pain and sucrose treatment
2024, Current Research in Pharmacology and Drug DiscoveryParental Participation in Their Infants’ Procedural Pain Alleviation with Nonpharmacologic Methods in Estonia
2023, Pain Management NursingPain in Neonates: Perceptions and Current Practices
2023, Critical Care Nursing Clinics of North America
Disclosure: None.
The authors would like to acknowledge the NIGMS IDeA Program award P30 GM110702 (R.W. Hall), the European Economic Commission – FP7 Programme, and the Oxnard Foundation (K.J.S. Anand) for research funding during the preparation of this article.