Pain Control In Newborns - APA

Running head: PAIN CONTROL IN NEWBORNS 1

Benefits of Non-Pharmacological over Pharmacological Pain Control in Newborns

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PAIN CONTROL IN NEWBORNS 2

Benefits of Non-Pharmacological over Pharmacological Pain Control in Newborns

Despite an established method of identifying pain in newborns, the perception of pain in

newborns is based on the opinion of the observer and lacks subjectivity. This makes

interventions aimed at control also a bit speculative and at times deemed unnecessary. Rightly

put, a precautionary approach to pain control in newborns should be applied in cases of doubt.

The thought on a precautionary approach follows the outcome of several studies that pain control

in newborns even when noxious stimuli is anticipated remains largely unapplied. Moreover,

there are a number of options that can be considered. Such consideration can be based on the

type of pain and the benefits of using one particular method over another. Some of the pain

control methods frequently adopted in newborns include:

 Pharmacological; analgesics and anesthetics

 Non-pharmacological; sucking (non-nutritive), sweeteners, acupuncture, massage,

kangaroo care, facilitated tucking, music, swaddling

Several specific benefits and limitations, both short and long term, are associated with each of

the above pain control methods. Generally, neonates whose pain was well controlled showed a

better clinical outcome overall than those in which pain stimuli were ignored; additionally, they

had better outcomes in terms of neurodevelopment in the long-term such as non-exaggerated

responses in subsequent pain experiences. The current paper aims at exploring the benefits of

using non-pharmacological pain control methods over pharmacological ones. Based on the

existing literature, the specific objective is to determine the benefits and limitations of either

method, to identify which approach has benefits that outweigh the limitations, and to identify

ways that can promote the uptake of the most beneficial approach.

PAIN CONTROL IN NEWBORNS 3

The research by Santos et al. (2015) demonstrates the effectiveness of non-nutritive

sucking and containment in controlling pain in the mildly intrusive procedure of blood sample

collection. In their findings, the researchers report a significant reduction in pain sensation

during lancing when either of the two non-pharmacological methods was applied, and when the

two methods were applied in combination. Additionally, there was significant difference in pain

sensation reduction between the combined therapy and the individual method (Santos, 2015).

The researchers reiterated the importance of pain control in newborns; prevent future

neurodevelopmental problems and provide a better clinical outcome for the condition presently

under investigation. They state that unmanaged pain causes physiologic changes in the neonate

and hemodynamic imbalances that contribute to the short-term and long term effects (Santos,

2015). The findings clearly indicate that in affordable, timely, and natural ways, pain control in

newborns and the amelioration of the long-term undesirable effects of unmanaged pain can be

achieved (. Non-pharmacological nursing interventions in newborns with mild and acute pain are

effective and easy to adopt in terms of decision-making.

Reliability is the extent to which a research instrument consistently measures what it

claims to measure. For reliability, the results obtained using the instrument should be

consistently reproducible under similar conditions by different researchers. The internal

reliability based on the test instrument and the corresponding results is brought to question in the

light of observer-based rating. Although the scoring is based on an established matrix, the

observer may interpret a similar observation differently based on the current mental status and

prevailing circumstances (inherent observer bias). This makes the expectation of consistency

unattainable. However, the study gets a boost in terms of internal reliability when the researchers

attempt to compare their findings with previous suggestions by other researchers, in their

PAIN CONTROL IN NEWBORNS 4

discussion sections. Notably, an increased reliability has a direct boost on the overall validity of

the study.

Validity is the degree to which a measurement tool really measures what it claims to

measure. For a research work to be valid the research instrument used should clearly address the

research question it claims to address. By using an established pain scoring instrument (Pain

Rating Scale Neonatal- NIPS) to address the research question, Santos and colleagues contribute

to increased overall research validity through the use of an appropriate and reliable instrument.

The instrument is designed to measure only pain and puts into consideration the theoretical

aspects associated with pain in newborns (Du Prel, Röhrig, & Blettner, 2009). The content

validity is increased by the fact that the researchers use two elements (containment and non-

nutritive sucking) within a category, non-pharmacological pain control methods, to test with their

instrument. This indirectly also increases the extent to which the results are generalizable to the

category. A general boost to the study validity is also derived from the fact that the researchers

first obtained an informed consent from the participants before initiating the study. However, the

external validity that is concerned with the sampling procedure used for the Santos et al., study is

limited to only hospitalized newborns (2015). External validity could be enhanced by extending

the sampling to include outpatient newborns subject to mildly and acutely painful care situations.

The study by Santos and colleagues, like any other study, has points of strengths and

limitations as well. The strength of the current study mostly lies in the inclusion of a control

group in the sampling and data collection process. The comparison between the two groups

clearly gives the difference between the non-intervened and intervened group in pain

management. However, considering that pain is internally constructed and highly individualized,

scoring the pain response using a placebo (non-pain inducing element) some minutes before the

PAIN CONTROL IN NEWBORNS 5

real procedure for both groups would have provided a more accurate representation of the pain

response both in the presence absence of intervention. Several factors come in to play in pain

development and response; putting into consideration such factors will reduce the interference

effect with the interpretation of response due to the presently applied pain stimulus (Du Prel,

Röhrig, & Blettner, 2009). Use of a standardized pain scoring instrument in the data collection

also strengthens the study by improving on the validity; it limits observer bias and improves on

reliability. Considering the topic of the study and the study objectives, a major weakness of the

study appears to within the sampling procedure. Considering the definition of a newborn, the

study excludes most of the newborns; firstly, the sample was only obtained from hospitalized

cases, and specifically from the ICU unit of the neonates. Interestingly, the pain parameter under

measurement as a pain inducer i.e. lancing for blood samples is a common procedure among

newborns (including outpatients) for care purposes. Consequently, the sampling reduces the

study generalizability to only newborns placed in the ICU. This questions the researchers’ choice

of the topic and words for describing the objectives. As a suggestion, the researchers should have

included outpatient newborn attending the procedure as well as hospitalized non-ICU newborns

in their sample in order to make it more representative. Alternatively, the topic and the objectives

should be narrowed down to only what was addressed by the study.

The National Institute for Health and Care Excellence (NICE) offers a number of

guidelines on the nursing practice. For instance, non-pharmacological interventions are

recommended in routine and minor procedures that elicit pain. The use of topical anesthetics is

recommended for such procedures as lumbar puncture but a warning is issued on repeated use;

additionally, the method is said to be ineffective in the common procedure of drawing blood

samples (NICE). Drug analgesics use in newborns has been associated with toxicity and adverse

PAIN CONTROL IN NEWBORNS 6

body reactions. Consequently, the use of this method in pain control is limited to the short-term

and in situations deemed extremely painful. Additionally, even for major pain control

procedures, NICE recommendations emphasize combining non-pharmacological procedures with

the pharmacological approach chosen for maximum pain and stress control. Overall from the

NICE guidelines, mild and acute pain can be effectively controlled using non-pharmacological

approach without fear of side effects. On the other hand, controlling pain of a chronic nature and

during prolonged and very painful procedures such as surgery requires the use of anesthetics and

drug analgesics, in addition to applicable non-pharmacologic methods.

Several non-pharmacological methods and those involving environment modifications

showed efficacy in pain relief in newborns subjected to minor procedures involving skin

invasion; these included swaddling, non-nutritive sucking, breastfeeding, sucrose use, and

kangaroo care among others. The efficacy of music as a pain intervention was not concluded

(Lago et al., 2014). The non-pharmacological method represents an easy, fast and affordable way

of fulfilling the nursing ethical requirement to minimize pain as much as possible. The methods

have an added advantage of having no side effects, calming the primary care givers (parents) of

the newborn (Lago et al., 2014).

In conclusion, control of pain in newborns is necessary for the best outcome clinically

and in the neurodevelopment of the newborn, apart from being an ethical requirement in nursing.

Since there are a number of options available for the pain control; choosing the appropriate

methods will require the consideration of such factors as the type of pain, the benefits and the

limitations associated with any particular method. The current paper explored non-

pharmacological pain control in newborns with the aim of checking whether the methods in this

category presented benefits over the commonly used pharmacological methods. From the review

PAIN CONTROL IN NEWBORNS 7

of literature presented here, non-pharmacological methods are effective in pain control at the

least inconvenience of the newborn and the nurse. The limitation to the use of these methods as

compared to the pharmacological approach lies in the nature of the pain; pharmacological

methods are better in the control of prolonged pain in such procedures as surgery and in cases of

chronic pain. However, pharmacological methods are associated with a plethora of side effects;

additionally, the pharmacological methods are used in combination with non-pharmacological

ones. Suffice to say, non-pharmacological methods are indispensable in the routine control of

pain in newborns. Consequently, nurses should never ignore the use of such easily available

methods in the fulfillment of their ethical call to minimize patient pain and suffering. There

should be established recruitment procedures of such methods for all anticipated pain in the care

of newborns.

PAIN CONTROL IN NEWBORNS 8

References

Du Prel, J.-B., Röhrig, B., & Blettner, M. (2009). Critical Appraisal of Scientific Articles: Part 1

of a Series on Evaluation of Scientific Publications. Deutsches Arzteblatt

International, 106(7), 100–105. http://doi.org/10.3238/arztebl.2009.0100

Lago, P., Garetti, E., Pirelli, A., Merazzi, D., Bellieni, C. V., Levet, P. S., … Ancora, G. (2014).

Non-pharmacological intervention for neonatal pain control. Italian Journal of

Pediatrics, 40(Suppl 2), A52. http://doi.org/10.1186/1824-7288-40-S2-A52

National Institute for Health and Care Excellence, Canadian Pediatric Association, Position

statement on Prevention and management of pain in the neonate: An update [Internet,

last updated Jan 30 2017; cited Feb 16 2017] Available from

http://www.cps.ca/en/documents/position/prevention-management-pain-neonate

Santos, G.C., Lima, L.M., Oliveira, G.B. et al.(2015). Nursing Intervention for Pain Control in

Newborns: Effectiveness of Non-Pharmacological Actions. Journal of Nursing.

ISSN:1981-8963, DOI:10.5205/reuol.7696-67533-1-SP-1.0908201504

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