The "standard" definition of pain is that of the International Association for the Study of Pain: "An unpleasant sensory or emotional experience associated with actual or potential tissue damage. Each individual learns the application of the word through experience related to injury in early life. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is no way to distinguish their experience from that due to tissue damage, if we take this subjective report". -To feel the pain,the following events occur: 1-Pain receptors(Nociceptors)in the skin are activated by tissue damage. 2-Asignal travels up the peripheral nerve to the spinal cord. 3-Within the spinal cord.chemical messengers(Neurotransimitters) released ,these activate other nerves that pass signals to the brain. 4-The thalamus relays the signals on the somatosensory cortex(Sensation),frontal cortex(Thinking) and limbic system(Emotional response) -Detecting and quantifying pain sensation in infants and neonates is a complex task due to the fact that the non-verbalizing newborn and young child cannot communicate this subjective phenomenon. This phenomenon led to the failure of health care professionals to recognize and treat pain appropriately during early life. Given there is no topologic gold standard
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for assessing pain in infants. Physiologic, biobehavioural and behavioural indicators need to be considered as surrogate markers for self-report.
-For pain assessment , the previous multiple indicator pain measures can be classified as Unidimensional or multidimensional approaches with composite measures being a subdivision within multidimensional measures that describe measures that encompass more than one type of indicator.
- Neonatal Infant pain scale (NPIS) soring system is the most reliable ,valid and practical score used in both preterm and fullterm babies. -for pain management , guidelines were established according to Neonatal Infant pain scale( NPIS ). Our study was conducted in the neonatal intensive care units of Benha university hospital in the period between May 2013 to April 2014.
The aim of our work was to analyze the type and the frequency of painful procedures performed to the studied population during the first 14 days of their life in the neonatal intensive care unit , the change of the number of these procedures according to state of ventilation and gestational age , to assess the degree of pain exposure resulting from intravenous cannulation and venipuncture using Neonatal Infant Pain Scale( NIPS) scoring system, to assess the nature of analgesia given to such babies and to assess the change in Neonatal Infant Pain Scale( NPIS )scoring system with and without different methods for pain management . our study was conducted on 50 patients.
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-all included neonates were admitted in the neonatal intensive care units, within the first 24 hours of their life and were followed during the first 14 days of their life in neonatal intensive care units . - Both sex were involved in the study. - Babies who died or were discharged before day fourteen were excluded from the study.
In our study, the mean number of painful procedure ± SD (Range) = 20.0 ± 2.47(16-24)
-The most common diagnosis among the studied population was the RDS(Respiratory Distress Syndrome).
-The most frequent used painful procedure was oral & nasal suctioning which represent 41.6% of all painful procedures done.
-In trials of intravenous canulation , grading of pain, according to Neonatal Infant pain scale (NIPS) revealed that
4% show mild to moderate pain.
84% show moderate to severe pain.
12% show severe pain.
-In trails of venipunctue, grading of pain, acceding to Neonatal Infant pain scale( NPIS) score revealed that
8% show mild to mod pain
80 % show moderate to severe pain
12% show severe pain
-In intravenous cannulation and venipuncture
87.7 % of babies given no analgesia
3.52 % given non specific analgesia
8.74% given specific analgesia.
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-The group showing moderate to severe pain showed obvious changes in the scale before & after giving non pharmacological & pharmacological agents. |
