Non-pharmacological management of neonatal pain: Research and clinical practice in the Neonatal Intensive Care Unit
Keywords:
Infants, Pain, Pain managementAbstract
According to the World Health Organization and the International Association for the Study of Pain, pain is a relevant worldwide problem in the healthcare field. The present study aimed to describe the definition of pediatric pain and the main characteristics, and to examine the findings regarding the impact of pain on the development of the child. The best clinical practices in Neonatal Intensive Care Units should include developmental care and specifically implement pain management, aiming to protect the health and development of the infants. The efficacious non-pharmacological management of neonatal pain includes breastfeeding, skin-to-skin, non-nutritive sucking, facilitated-tucking and swaddling. Sweet solutions also have pain relief effects. Psychologists could actively participate in the implementation of non-pharmacological interventions and in the whole process to sensitize and train the professional teams, to alert parents to protection against pain and to support policymakers in the implementation of pain guidelines in the hospital.
Downloads
References
Als, H. (1982). Toward a synactive theory of development: Promise for the assessment and support of infant individuality. Infant Mental Health Journal, 3(4), 229-243. https://doi.org/10.1002/1097-0355(198224)3:4<229::AID-IMHJ2280030405>3.0.CO;2-H
Als, H., Duffy, F. H., McAnulty, G. B., Rivkin, M. J., Vajapeyam, S., Mulkern, R. V., & Eichenwald, E. (2004). Early experience alters brain functions and structure. Pediatrics, 113(4), 846-857. https://doi.org/10.1542/peds.113.4.846
Als, H., Gilkerson, L., Duffy, F. H., McAnulty, G. B., Buehler, D. M., Vandenberg, K, & Jones, K. J. (2003). A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: Medical, neurodevelopmental, parenting, and caregiving effects. Journal of Developmental and Behavioral Pediatrics, 24(6), 399-408.
Campbell-Yeo, M. L., Johnston, C. C., Joseph, K. S., Feeley, N., Chambers, C. T., & Barrington, K. J. (2012). Cobedding and recovery time after heel lance in preterm twins: Results of a randomized trial. Pediatrics, 130(3), 500-506. https://doi.org/10.1542/peds.2012-0010
Catelin, C., Tordjman, S., Morin, V., Oger, E., & Sizun, J. (2005). Clinical, physiologic, and biologic impact of environmental and behavioral interventions in neonates during a routine nursing procedure. Journal of Pain, 6(12), 791-797. https://doi.org/10.1016/j.jpain.2005.07.010
Cignacco, E., Hamers, J. P., Stoffel, L., van Linger, R. A., Gessler, P., McDougall, J., & Nelle, M. (2007). The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. European Journal of Pain, 11(2), 139-152. https://doi.org/10.1016/j.ejpain.2006.02.010
Committee on Fetus and Newborn & Section on Anesthesiology and Pain Medicine. (2016). Prevention and management of procedural pain in the neonate: An update. Pediatrics, 137(2), e20154271. https://doi.org/10.1542/peds.2015-4271
Cong, X., Cusson, R. M., Walsh, S., Hussain, N., Ludington-Hoe, S. M., & Zhang, D. (2012). Effects of skin-to-skin contact on autonomic pain responses in preterm infants. The Journal of Pain, 13(7), 636-645. https://doi.org/10.1016/j.jpain.2012.02.008
Cong, X., Ludington-Hoe, S. M., & Walsh, S. (2011). Randomized crossover trial of Kangaroo Care to reduce biobehavioral pain responses in preterm infants: A pilot study. Biological Research for Nursing, 13(2), 204-216. https://doi.org/10.1177/1099800410385839
Craig, J. W., Glick, C., Phillips, R., Hall, J. S., Smith, J., & Browne, J. (2015). Recommendations for involving the family in developmental care of the NICU baby. Journal of Perinatology, 35, 55-58. https://doi.org/10.1038/jp.2015.142
Fernandes, A., Campbell-Yeo, M., & Johnston, C. (2011). Procedural pain management for neonates using nonpharmacological strategies. Advances in Neonatal Care, 11(4), 235-241. https://doi.org/10.1097/ANC.0b013e318225a2c2
Gaspardo, C. M., Chimello, J. T., Cugler, T. S., Martinez, F. E., & Linhares, M. B. M. (2008). Pain and tactile stimuli during arterial puncture in preterm neonates. Pain, 140(1), 58-64. https://doi.org/10.1016/j.pain.2008.07.004
Gaspardo, C. M., Martinez, F. E., & Linhares, M. B. M. (2010). Developmental care: Protection approach for early development of preterm infants. Revista Paulista de Pediatria, 28(1), 77-85. https://doi.org/10.1590/S0103-05822010000100013
Gaspardo, C. M., Miyase, C. I., Chimello, J. T., Martinez, F. E., & Linhares, M. B. M. (2008). Is pain relief equally efficacious and free of side effects with repeated doses of oral sucrose in preterm neonates? Pain, 137(1), 16- 25. Garner, A. S., Shonkoff, J. P., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., … Wood, D.L. (2012). Early childhood adversity, toxic stress, and the role of the pediatrician: Translating science into lifelong health. Pediatrics, 129(1), 224-231. https://doi.org/10.1542/ peds.2011-2662
Goffaux, P., Lafrenaye, S., Morin, M., Patural, H., Demers, G., & Marchand, S. (2008). Preterm births: Can neonatal pain alter the development of endogenous gating systems? European Journal of Pain, 12(7), 945-951. https://doi.org/10.1016/j.ejpain.2008.01.003
Gorzílio, D. M., Garrido, E., Gaspardo, C. M., Martinez, F. E., & Linhares, M. B. M. (2015). Neurobehavioral development prior to term-age of preterm infants and acute stressful events during neonatal hospitalization. Early Human Development, 91(12), 769-775. https:// doi.org/10.1016/j.earlhumdev.2015.09.003
Hall, R. W., & Anand, J. K. (2014). Pain management in newborns. Clinics in Perinatology, 41(4), 895-924. https://doi.org/10.1016/j.clp.2014.08.010
Hynan, M. T., & Hall, S. L. (2015). Psychosocial program standards for NICU parents. Journal of Perinatology, 35(Suppl.1), 51-54. https://doi.org/10.1038/jp.2015.141
International Association for the Study of Pain. (1994). IASP taxonomy. Retrieved November 30, 2016, from http:// www.iasp-pain.org/Taxonomy?navItemNumber=576
Johnston, C. C., Campbell-Yeo, M., Fernandes, A., Inglis, D., Streiner, D., & Zee, R. (2014). Skin-to-skin care for procedural pain in neonates. Cochrane Database System Review, 1:CD008435. https://doi. org/10.1002/14651858.CD008435.pub2
Johnston, C. C., Campbell-Yeo, M., & Filion, F. (2011). Paternal vs maternal Kangaroo Care for procedure pain in preterm neonates: A randomized crossover trial. Archives of Pediatric and Adolescent Medicine Journal, 165(9), 792-796. https://doi.org/10.1001/ archpediatrics.2011.130
Johnston, C., Byron, J., Filion, F., Campbell-Yeo, M., Gibbins, S., & Ng, E. (2012). Alternative female Kangaroo Care for procedural pain in preterm neonates: A pilot study. Acta Paediatrica, 101(11), 1147-1150. https://doi. org/10.1111/j.1651-2227.2012.02813.x
Lefrak, L., Burch, K., Caravantes, R., Knoerlein, K., DeNolf, N., Duncan, J., … Toczylowski, K. (2006). Sucrose analgesia: Identifying potentially better practices. Pediatrics, 118(Suppl.2), 197-202. https://doi. org/10.1542/peds.2006-0913R
Linhares, M. B. M. (2016). Early childhood stress: Impacts on health and protective mechanisms. Estudos de Psicologia (Campinas), 33(4), 587-599. https://doi. org/10.1590/1982-02752016000400003
Linhares, M. B. M., Gaspardo, C. M., Souza, L. O., Valeri, B. O., & Martinez. (2014). Examining the side effects of sucrose for pain relief in preterm infants: A case-control study. Brazilian Journal of Medical and Biological Research, 47(6), 527-532. https://doi. org/10.1590/1414-431X20143659
Linhares, M. B. M., Doca, F. N. P., Martinez, F. E., Carlotti, A. P. P., Cassiano, R. G. M., Pfeifer, L. I., ... Finley, G. A. (2012). Pediatric pain: Prevalence, assessment, and management in a teaching hospital. Brazilian Journal of Medical and Biological Research, 45(12), 1287-1294. https://doi.org/10.1590/S0100-879X2012007500147
Matar, E. M., Arabiat, D. H., & Foster, M. J. (2016). Oral glucose efficacy on neonate’s pain responses at the NICU: A quasi experimental trial of two clinical procedures. Applied Nursing Research, 32, 36-40. https://doi.org/10.1016/j.apnr.2016.04.002
Matsuda-Castro, A. C., & Linhares, M. B. M. (2014). Pain and distress in inpatient children according to child and mother perception. Paidéia, 24(2), 351-359. https:// doi.org/10.1590/1982-43272459201409
Mokhnach, L., Anderson, M., Glorioso, R., Loeffler, K., Shinabarger, K., Thorngate, L., … Zbirun I. (2010). NICU procedures are getting sweeter: Development of a sucrose protocol for neonatal procedural pain. Neonatal Network, 29(5), 271-279. https://doi. org/10.1891/0730-0832.29.5.271
Newnham, C. A., Inder, T. E., & Milgrom, J. (2009). Measuring preterm cumulative stressors within the NICU: The Neonatal Infant Stressor Scale. Early Human Development, 85(9), 549-555. https://doi. org/10.1016/j.earlhumdev.2009.05.002
Montirosso, R., Del Prete, A., Bellù, R., Tronick, E., Borgatti, R., & Neonatal Adequate Care for Quality of Life (NEO-ACQUA) Study Group. (2012). Level of NICU quality of developmental care and neurobehavioral performance in very preterm infants. Pediatrics, 129(5), 1129-1137. https://doi.org/10.1542/peds.2011-0813
Ohgi, S., Fukuda, M., Akiyama, T., & Gima, H. (2004). Effect of an early intervention programme on low birthweight infants with cerebral injuries. Journal of Paediatric Child Health, 40(12), 689-695. https://doi. org/10.1111/j.1440-1754.2004.00512.x
Padovani, F. H. P., Carvalho, A. E. V., Duarte, G., Martinez, M. B. M., & Linhares, M. B. M. (2009). Anxiety, dysphoria and depression symptoms in mothers of preterm infants. Psychological Reports, 104(2), 667- 679. https://doi.org/10.2466/pr0.104.2.667-679
Phillips, R. M. (2015). Seven core measures of neuroprotective family-centered developmental care: Creating an infrastructure for implementation. Newborn & Infant Nursing Reviews, 15(3), 87-90. https://doi.org/10.1053/j.nainr.2015.06.004
Roofthooft, D., Simons, S., Anand, K., & van Dijik, M. (2014). Eight years later, are we still hurting newborn infants? Neonatology, 105(3), 218-226. https://doi.org/10.1159/000357207
Sameroff, A. J. (2009). Conceptual issues in studying the development of self-regulation. In S. L. Olson & A. J. Sameroff (Eds.), Biopsychosocial regulatory processes in the development of childhood behavioral problems. New York: Cambridge University Press.
Schechter, N. L., Finley, G. A., Bright, N. S., Laycock, M., & Forgeron P. (2010). ChildKind: A global initiative to reduce pain in children. Pediatric Pain Letter, 12(3), 26-30.
Shonkoff, J. P. (2010). Building a new biodevelopmental framework to guide the future of early childhood policy. Child Development, 81(1), 357-367. https://doi.org/10.1111/j.1467-8624.2009.01399.x
Shonkoff, J. P. (2012). Leveraging the biology of adversity to address the roots of disparities in health and development. Proceedings of the National Academy of Science of the United States of America, 109(2), 17302-17307. https://doi.org/10.1073/pnas.1121259109
Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., … Wood, D. L. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), 232-246. https://doi.org/10.1542/peds.2011-2663
Shonkoff, J. P., & Levitt, P. (2010). Neuroscience and the future of early childhood policy: Moving from why to what and how. Neuron, 67(5), 689-691. https://doi.org/10.1016/j.neuron.2010.02.032
Sizun, J., Ansquer, H., Browne, J., Tordjaman, S., & Morin, J. F. (2002). Developmental care decreases physiologic and behavioral pain expression in preterm neonates. Journal of Pain, 3(6), 446-450.
Stevens, B. J., Abbott, L. K., Yamada, J., Harrison, D., Stinson J., Taddio, A., … CIHR Team in Children’s Pain. (2011). Epidemiology and management of painful procedures in children in Canadian hospitals. Canadian Medical Association Journal, 183(7), 403-410. https://doi.org/10.1503/cmaj.101341
Stevens, B. J., McGrath, P., Gibbins, S., Beyene, J., Breau, L., Camfield, C., ... Yamada, J. (2007). Determining behavioural and physiological responses to pain in infants at risk for neurological impairment. Pain, 127(1- 2), 94-102. https://doi.org/10.1016/j.pain.2006.08.012
Stevens, B., Yamada, J., Ohlsson, A., Haliburton, S., & Shorkey, A. (2016). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database System Review, 1:CD001069. https://doi.org/10.1002/14651858.CD001069.pub5
Symington, A., & Pinelli, J. M. (2002). Distilling the evidence on developmental care: A systematic review. Advances in Neonatal Care, 2(4), 198-221.
Taylor, E. M., Boyer, K., & Campbell, F. A. (2008). Pain in hospitalized children: A prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital. Pain Research and Management, 13(1), 25-32.
Valeri, B. (2015). Reatividade à dor em neonatos pré-termo sob intervenção de sacarose, em grupos diferenciados pelo risco clínico neonatal (Tese de doutorado não-publicada). Universidade de São Paulo.
Valeri, B. O., Gaspardo, C. M., Martinez, F. E., & Linhares, M. B. M. (2012). Does the neonatal clinical risk for illness severity influence pain reactivity and recovery in preterm infants? European Journal of Pain, 16(5), 727-736. https://doi.org/10.1002/j.1532-2149.2011.00037.x
Valeri, B. O., Holsti, L., & Linhares, M. B. (2015). Neonatal pain and developmental outcomes in children born preterm. The Clinical Journal of Pain, 31(4), 355-362. https://doi.org/10.1097/AJP.0000000000000114
Williams, A. C., & Craig. K. D. (2016). Updating the definition of pain. Pain, 157(11) 2420-2423. https://doi.org/10.1097/j.pain.000000000000613
Williams, A. L., Khattak, A. Z., Garza, C. N., & Lasky R. E. (2009). The behavioral pains response to heel stick in preterm neonates studied longitudinally: Description, development, determinants, and components. Early Human Development, 85(6), 369-374. https://doi.org/10.1016/j.earlhumdev.2009.01.001
World Health Organization. (2016). Preterm birth: Fact sheet. Retrieved November 2, 2016, from http://www.who.int/mediacentre/factsheets/fs363/en/
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Maria Beatriz Martins LINHARES, Cláudia Maria GASPARDO

This work is licensed under a Creative Commons Attribution 4.0 International License.







