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Are pain scales for acute pain necessary?


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Several scales to assess pain in newbrns exist: both for acute and for postsurgical pain. Scales for postsurgical or chronical pain are few and easy to use.   I recently wondered if pain scales for acute pain are really necessary: they seem scarcely used in clinical practice though they are more than 40(!), they are often complicated, and -above all- they give a pain score when the procedure is over, i.e., when (I fear) it is too late. Acute pain scales do not consider the context of the procedure, but only babies' reactions; therefore they should simultaneously use and combineseveral indicators. I proposed to settle for pain detection instead of pain scoring. It is easy: you should first wonder if your procedure can actually stimulate nociceptors, then you should see if it provokes a sudden reaction: this is a contextual detection of pain: easy, reliable and useful.


What is your opinion about this idea?


Acta Paediatr. 2015 Mar;104(3):221-4. doi: 10.1111/apa.12882. Epub 2015 Jan 7.

Should we assess pain in newborn infants using a scoring system or just a detection method?


Newborn infants' pain should be scored indirectly using dedicated pain scales. Unfortunately, while some scales for prolonged pain have given good results, a gold standard to assess acute pain does not exist. Acute pain scales still have weak points, most are complex and are scarcely used in neonatal departments. Moreover, carefully scoring pain in clinical practice seems redundant, because any avoidable pain is a concern. This suggests that researchers must find new ways to assess acute pain. A possible approach is to settle for pain detection instead of pain scoring in selected cases. Here, we describe a two-point method that illustrates this approach.


For everyday practice, detecting pain is more useful than scoring it; acute pain scales should be reserved for research, for those clinical settings where the personnel has received a careful training and where overcrowding and hurry are absent.

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