A Systematic Integrative Review of Infant Pain Assessment Tools

Lenora J. Duhn, RN, MSc; Jennifer M. Medves, RN, PhD


Adv Neonatal Care. 2004;4(3) 

In This Article

Abstract and Introduction

Purpose: To examine the issue of pain assessment in infants by acquiring all available published pain assessment tools and evaluating their reported reliability, validity, clinical utility, and feasibility.
Design and Methods: A systematic integrative review of the literature was conducted using the following databases: MEDLINE and CINAHL (through February 2004), and Health and Psychosocial Instruments, and Cochrane Systematic Reviews (through 2003). MeSH headings searched included "pain measurement," with limit of "newborn infant"; "infant newborn"; and "pain perception."
Subjects: Thirty-five neonatal pain assessment tools were found and evaluated using predetermined criteria. The critique consisted of a structured comparison of the classification and dimensions measured. Further, the population tested and reports of reliability, validity, clinical utility, and feasibility were reviewed.
Results: Of the 35 measures reviewed, 18 were unidimensional and 17 were multidimensional. Six of the multidimensional measures were published as abstracts only, were not published at all, or the original work could not be obtained. None of the existing instruments fulfilled all criteria for an ideal measure; many require further psychometric testing.
Conclusions: When choosing a pain assessment tool, one must also consider the infant population and setting, and the type of pain experienced. The decision should be made after carefully considering the existing published options. Confidence that the instrument will assess pain in a reproducible way is essential, and must be demonstrated with validity and reliability testing. Using an untested instrument is not recommended, and should only occur within a research protocol, with appropriate ethics and parental approval. Because pain is a multidimensional phenomenon, well-tested multidimensional instruments may be preferable.

Infant pain assessment is not universally standardized. Practitioners may assess pain; however, they may not consistently use the same criteria to do so. This leads to differing interpretations of the infant's level of pain and diminishes the effectiveness of pain management strategies. There are a number of barriers that prevent the use of a standard tool: inconsistent assessment and interpretation of pain cues; health care professional beliefs about neonatal pain; and variation in pain management strategies. To treat pain, its existence must be acknowledged and assessed as "…neonates need to be comfortable and as free of pain as possible to grow and develop normally."[1]


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