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

Implications for Clinical Practice

The International Association for the Study of Pain describes pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."[71] It is further acknowledged that "the inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment."[71] The inability to verbally communicate is particularly relevant to the infant, and, while the obvious self-report is lacking, caregivers must attend to all possible cues of pain expression, recognizing that the experience of pain for the infant may be a very real one. The assumption is that through the use of a standardized pain assessment tool, enhanced pain management will result; however, these types of evaluative studies are beyond the scope of this article.

There are several steps to address when considering implementation of a pain assessment tool. Confidence that the pain tool is indeed assessing pain and doing so in a reproducible way will depend on report of its psychometric properties (validity and reliability). Using a tool that has not been tested for reliability and validity should be framed within a research protocol with the appropriate ethics and parental approval. Clinicians should be aware that blending or modifying tools may interfere with their psychometric properties, and as such, modified tools require new testing.

Considering whether a specific tool is designed for research purposes and/or clinical practice also needs examination. The population that the tool has been tested with is important to review. Further testing may be required if a different population is targeted.

It is also important to have philosophical support of the need for integrating a standardized assessment tool into practice. Commitment that all health care practitioners will adopt its use will ensure maximum benefit of its value. As such, part of the initial stage of selecting a tool should involve communication and education with well-developed resource materials, followed by a testing phase to determine the most appropriate fit with the clinical setting and its practitioners. To ensure the testing phase is most effective, contacting the primary author or other centers where the tool is in use are helpful ways to ensure there is no misinterpretation of how the tool is to be used. Selection of a final tool will need to ensure practitioner satisfaction that the tool is feasible for use in clinical practice in a meaningful and reasonable manner. The pain assessment can be performed at the bedside, incorporating parents' observations and input, to support parental involvement in the care of their infant and, in particular, to heighten their awareness of their infant's pain cues.


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