Pain in babies is poorly measured, warns study

There are more than twenty scales for measuring pain in babies. And yet, none of them are effective, according to the independent medical NGO. CochraneIt therefore calls for urgent improvements to the tools used to care for toddlers.

Between 6 and 91 infants require intensive care, either because they are ill or premature. Unfortunately, many painful procedures are used in hospitals to treat them. Among the most common are heel pricks, a minimally invasive method for collecting blood, and venipuncture, also used to obtain a blood sample. Intramuscular injections, intravenous injections, lumbar punctures, and insertion of a urinary catheter, nasogastric tube, or chest drain to facilitate breathing are also part of the daily lives of these young patients.

Suffering without relief

Unable to communicate through speech at this age, it is difficult for them to express whether a movement is too painful. To compensate for this lack, more than 40 pain scales have been developed to understand whether they are suffering or not. Pain detection depends on the scale used but is based on several symptoms such as crying, irritability, facial expressions (relaxed, grimacing, frowning, squinting), tone (relaxed or more intense movements) as well as vital signs (heart rate, breathing rate, oxygen saturation). Pain detection in premature babies and infants who are very sick and on artificial respiration is even more difficult because they do not show any signs of pain such as crying or facial expressions.", explains to Science and Future Emma Persad, study co-author and Cochrane Fellow.

In its new meta-analysis, the NGO reviewed 79 studies involving 7,000 infants across 26 countries. In total, 27 pain scales were evaluated. All were found to be of poor quality, strongly suggesting that they are ineffective and clinically inapplicable. But how can we determine whether these scales work if detecting pain in infants is so complicated in the first place? The right questions had to be asked. From a methodological point of view, how were the scales developed? Do they cover all aspects of pain well? Are they reliable? Do two people get the same result at the same time? Does one person always get the same result at different times? Are the results obtained on the scale applicable?" lists Emma Persad.

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A lower pain tolerance threshold

Young patients run two major risks: having their pain overestimated and receiving painkillers they don't need; and having their pain underestimated and suffering without relief. Beyond the discomfort experienced at the time, these inaccuracies can have long-term repercussions for patients. Repeated exposure to painful procedures is thought to impact pain perception and response. Neurodevelopmental delays are also thought to be related to pain exposure, in addition to structural brain alterations. In addition, infants often require more frequent and invasive procedures, which are thought to result in a lower pain threshold and potentially make them more susceptible to future painful interventions. says Emma Persad.

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However, it is impossible to say whether the infants are under-medicated or over-medicated. It's probably a mixture of both.", says the co-author of the study. The pain scales used today are methodologically unsound, to the point that we cannot be sure that we are measuring pain at all.. » A recent study by the Karolinska Institutet suggests that infants in Sweden are undermedicated. The youngest babies and those most exposed to pain were those receiving the least morphine.

“ But again, we now know that the pain scale used was not robust enough.. » Cochrane calls on healthcare professionals to focus on reducing painful procedures in this vulnerable population as much as possible and contribute to the establishment of a more rigorous pain scale. They call on all volunteers in the medical world to participate via this form.