How Pain Scores In Babies

Main Category: Pain / Anesthetics
Also Included In: Pediatrics / Children's Health
Article Date: 24 Jun 2008 - 2:00 PDT

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Methods commonly used by doctors to assess pain in infants may be underestimating the amount of pain they feel, according to a study by UCL (University College London) researchers. Clinical pain scoring methods, which look for a range of behavioural and physiological responses, such as body movements and changes in blood pressure, may need to be revised to focus on the strongest indicators of pain.  The findings have important long-term implications, given that repetitive pain in premature babies has been linked to learning and behavioural problems later in life.

The UCL study, published in the journal Public Library of Science Medicine, observed twelve prematurely born infants on thirty-three separate occasions while they had their heel lanced as part of a medical procedure. The UCL team measured brain activity in the babies at the same time as using a common scoring method called the premature infant pain profile (PIPP) to measure pain responses to the lancing.  A portable near-infrared spectrophotometer was used to measure regional changes in brain tissue oxygenation.

Researchers discovered that although changes in brain activity in the somatosensory cortex correlated with the pain scores, brain activity associated with pain processing was recorded in some infants even though, according to the PIPP score, there were no behavioural signs that the infants were in pain.

Dr Rebeccah Slater, lead author from UCL Neuroscience, Physiology and Pharmacology, says: "Although our study was small, it does raise concerns about the tools normally used by doctors to establish whether a baby is feeling pain. Infants may appear to be pain free, but may, according to brain activity measurements, still be experiencing pain. It would be exciting to explore whether measures of brain activity could complement current methods for measuring pain in infants."

'How well do clinical pain assessment tools reflect pain in infants?'
Rebeccah Slater, Anne Cantarella, Linda Franck, Judith Meek and Maria Fitzgerald
Public Library of Science Medicine, 24 June 2008

  The study was funded by the Medical Research Council, Wellcome Trust and SPARKS (children's medical research charity).

About UCL

Founded in 1826, UCL was the first English university established after Oxford and Cambridge, the first to admit students regardless of race, class, religion or gender, and the first to provide systematic teaching of law, architecture and medicine. In the government's most recent Research Assessment Exercise, 59 UCL departments achieved top ratings of 5* and 5, indicating research quality of international excellence.

UCL is in the top ten world universities in the 2007 THES-QS World University Rankings, and the fourth-ranked UK university in the 2007 league table of the top 500 world universities produced by the Shanghai Jiao Tong University. UCL alumni include Marie Stopes, Jonathan Dimbleby, Lord Woolf, Alexander Graham Bell, and members of the band Coldplay.

  http://www.ucl.ac.uk