It’s difficult to truly assess the pain level in infants and recently some researchers and clinicians in London have questioned the current methods used.
When babies are born very premature or are quite ill, they are exposed to painful procedures quite frequently and it can be difficult to know whether their pain is being managed properly. Is a baby crying just because babies cry sometimes or are they crying because they are truly in pain? And if they are in pain, how much pain are they in?
It is possible that undergoing frequent painful medical procedures like these can cause long-term harm on a baby’s nervous system. When a child is over exposed to pain during infancy, he or she can develop feeding and sleeping problems as well as chronic pain problems, learning and behavioral disorders. Children can become over sensitized to touch to where even the slightest things can feel painful.
Currently, infant pain (for preemies) is assessed using the premature infant pain profile (PIPP) that is based on behavioral and physiological body reactions like crying and facial expressions. While this system has its high points, it also has some problems. A flaw with this system is that it is, “largely dependent on unconscious reflexes and may not be reliably linked to central sensory processing in the brain.” (1)
Hospitals in the London region and the University of Oxford did a study where they measured the brain activity in infants to try and better understand their pain response. The new assessment was published in a unique video-based publication (Journal of Visualized Experiments (JoVE)).
This pain assessment technique evaluates the electrical activity in skeletal muscles and uses an EEG to detect activity in the areas of the brain where “unpleasant sensations” are processed (1). The study data was collected during times when the infants were undergoing medically necessary heel sticks (for routine blood collection).
The author of the study, Dr. Rebeccah Slater, says, “We want to help work out how effective pain treatments are and understand the effects of prematurity on pain, and whether prematurity has long-term implications on the pain response.”(2) JoVe is the very first and the only peer-reviewed video journal that is indexed in PubMed and MEDLINE. The video shows the technique used to measure pain in the infant.
I think what is really important is the larger implications here for pain management for preemies and infants. By being able to note pain in infants and whether or not it is being controlled, doctors will be able to intervene if necessary with pain medicine. This can go both ways. If a child is not experiencing too much pain, high doses of pain medications can be weaned if possible as well as unnecessary suffering can be avoided.
Because of publishing in a video journal, clinicians and researchers are able to easily see the new pain assessment technique and apply it. Dr. Slater states, “It’s quite hard to measure brain activity in premature infants…the methods are quite complicated and we wanted people to be able to do this technique.” (2)
Watch the video!
(1) The Journal of Visualized Experiments (2011, December 21). New method of infant pain assessment. ScienceDaily. Retrieved January
(2) L. Fabrizi, A. Worley, D. Patten, S. Holdridge, L. Cornelissen, J. Meek, S. Boyd, R. Slater. Electrophysiological Measurements and Analysis of Nociception in Human Infants. Journal of Visualized Experiments, 2011; (58) DOI: 10.3791/3118
Thanks for sharing! I am glad that researchers are looking into pain processing in premature infants and the possible long-term effects.