Pain management in the neonate

Pain

As a neonatal intensive care nurse, I need to be aware of special considerations when working with my patients. Pain in neonates may have serious consequences for the development of the child, especially with regards to the serious risk of neurodevelopmental impairment (American Academy of Pediatrics, 2006). Long-term pain could be indicators of serious issues. Because of this, "the prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences," (American Academy of Pediatrics, 2006, p. 2231).

Barriers to optimal pain management begins with the fact that neonates cannot verbalize their pain, and therefore, depend on the astute observation and wisdom of others around them to recognize, assess, and manage pain (The Royal Children's Hospital Melbourne, 2015). Not all nurses may be familiar with the gamut of signs that indicate the presence of pain, especially those that are less experienced. Furthermore, knowledge gaps still remain. Unfortunately, "there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates," (American Academy of Pediatrics, 2006, p. 2231). Pain in neonates can be caused by a variety of factors including disease development, a treatment intervention, or environmental toxins or stimuli.

The most important principles of pain management with neonates include "strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures," (American Academy of Pediatrics, 2006, p. 2231). Because some types of pain may be indicators of emerging or new conditions, healthcare workers need to monitor their patients carefully, especially when in the NICU.

It is critical to follow institutional policies and procedures, and to be aware of resources available to staff. The institutional policies and procedures involve systematic assessment for pain based on the Hodgkinson et al. (1994) Pain Assessment Tool (PAT) model. The model takes into account various visible indicators of discomfort and pain in the neonate, recognizing degrees. Resources for pain management include senior staff and online references to the PAT model. Routine assessment is critical. It may also be important to schedule invasive procedures in a way that minimizes overexposure to stimuli.