T. Blauer et D. Gerstmann, A SIMULTANEOUS COMPARISON OF 3 NEONATAL PAIN SCALES DURING COMMON NICU PROCEDURES, The Clinical journal of pain, 14(1), 1998, pp. 39-47
Objective: This study evaluated neonatal pain scales during procedures
commonly performed in a neonatal intensive care unit. Design: Evaluat
ed were the Neonatal Infant Pain Scale (NIPS), the Comfort scale, and
a new scale known as the Scale for Use in Newborns (SUN). Four procedu
res were scored: intubation, intravenous catheter insertion, endotrach
eal tube suctioning, and diaper changes. Scoring was done before, duri
ng, and after each procedure. Thirty-three patients were tested during
68 procedures with 1,428 scale scores. Results: All scales demonstrat
ed significant changes. In before-versus-during for each procedure, th
e increase in pain scale score was significant for the NIPS, Comfort s
cale, and SUN. All three scales also demonstrated a return to baseline
(before-vs.-after) for the four procedures, except for the Comfort sc
ale, which remained elevated (p <.05) following diaper change. The MPS
had a significantly larger coefficient of variation (CV, 188% +/- 99%
), whereas the Comfort scale and SUN had small CVs (27% +/- 5% and 33%
+/- 8%, respectively). In evaluating potential confounding influences
, it was found that infants >2.5 kg on sedative or analgesic medicatio
ns appeared to have procedure-related accentuation and sustained eleva
tion in scale scores, whereas swaddling seemed to provide little added
benefit. Conclusions: The pain scale scores identify changes in an in
fant's behavior/physiologic state. It is unclear whether these changes
are totally ''pain specific.'' In comparing the three scales, the SUN
overall was a preferable tool because of its ease of use, scale symme
try, and scoring consistency.