Pain Assessment using CRIES, FLACC and PIPP in High-Risk Infants

CRIES, FLACC, PIPP를 이용한 고위험영아의 통증사정

  • Published : 2005.12.01

Abstract

Purpose: Infants at neonatal intensive care units (NICU) are invariably exposed to various procedural and environmental stimuli. The study was performed to compare the pain responses in three NICU stimulants and to examine the clinical feasibility for NICU infants using CRIES, FLACC and PIPP. Method: In a correlational study, a total of 94 NICU stimulants including angio-catheter insertions, trunk-rubbings and loud noises, was observed for pain responses among 64 infants using CRIES, FLACC and PIPP. Results: A significant difference was identified among the mean scores in CRIES($F_{(2, 91)}$=47.847, p=.000), FLACC($F_{(2, 91)}$=41.249, p=.000) and PIPP($F_{(2. 91)}$=16.272, p=.000) to three stimulants. In a Post-hoc Scheff test, an angio-catheter insertion showed the highest scores in CRIES, FLACC and PIPP compared to the other two stimulations. A strong correlation was identified between CRIES and FLACC in all three stimulations(.817 < r < .945) while inconsistent findings were identified between PIPP and CRIES or FLACC. Conclusions: The results of the study support that CRIES and FLACC are reliable and clinically suitable pain measurements for NICU infants. Further studies are needed in data collection time-point as well as clinical feasibility on PIPP administration to assess pain response in infants, including premature infants.

Keywords

References

  1. Anand, K. J. S. & The International Evidence-Based Group for Neonatal Pain. (2001). Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med, 125, 173-180
  2. Fitzgerald, M. (2005). The development of nociceptive circuits. Nat Rev Neurosci, 6(1), 507-520
  3. Fitzgerald, M. & Beggs, S. (2001). The neurobiology of pain: developmental aspects. The Neuroscientists, 7(3), 246-257 https://doi.org/10.1177/107385840100700309
  4. Gibbsins, B., Stevens, B. & Asztalos, E. (2003). Assessment and management of acute pain in high-risk neonates. Expert Opin Pharmacother, 4(4), 475-483 https://doi.org/10.1517/14656566.4.4.475
  5. Grunau, R. E. (2002). Early pain in preterm infants: a model of long-term effects. Clin Perinatol, 29(3), 373-394 https://doi.org/10.1016/S0095-5108(02)00012-X
  6. Guinsburg, R., Peres, C. A., Almeida, M. F. B., Balda, R. C. X., Berenguel, R. C, Tonelotto, J. & Kopelman, B. I. (2000). Differences in pain expression between male and female newborn infants. Pain, 85, 127-133 https://doi.org/10.1016/S0304-3959(99)00258-4
  7. Holsti, L., Grunau, R. E., Oberlander, T. F. & Whitfield, M. F. (2004). Prior pain induced heightened motor responses during clustered care in preterm infants in the NICU. Early Hum Dev, 81(3), 293-302 https://doi.org/10.1016/j.earlhumdev.2004.08.002
  8. Johnston, C. C, Stevens, B., Craigm K. D., & Grunau, R. V. (1993). Developmental changes in pain expression in premature, full-term, two-and four-month-old infants. Pain, 52(2), 201-208 https://doi.org/10.1016/0304-3959(93)90132-9
  9. Krechel, S. W., & Bildner, J. (1995). CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatr Anaesth, 5(1), 53-61 https://doi.org/10.1111/j.1460-9592.1995.tb00242.x
  10. Manworren, R. C, & Hynan, L. S. (2003). Clinical validation of FLACC: preverbal patient pain scale. Pediatr Nurs, 29, 140-146
  11. McNair, C, Ballantyne, M., Dionne, K., Stephens, D., & Stevens, B. (2004). Postoperative pain assessment in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed, 89, F537-F541 https://doi.org/10.1136/adc.2003.032961
  12. Merkel, S. L., Shayevitz, J. R., Voepel-Lewis, T., & Malviya, S. (1997). The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs, 23(3). 293-297
  13. Nandi, R., & Fitzgerald, M. (2005). Opioid analgesia in the newborn. Eur J Pain, 9(2), 105-108 https://doi.org/10.1016/j.ejpain.2004.05.005
  14. Nelson, M. N., White-Traut, R. C, Vasan, U., Silvestri, J., Comiskey, E., Meleedy-Rey, P., Littau, S., Gu, G. & Patel, M. (2001). One-year outcome of auditory-tactile-visual-vestibular intervention in the neonatal intensive care unit: effects of severe prematurity and central nervous system injury. J Child Neurol, 16(1), 493-498
  15. Oakes, L. (2001). Caring practices: Providing comfort. In: Curley MAQ, Moloney-Harmon PA (eds), Critical Care Nursing of Infants and Children, 2nd edn. Philadelphia: Saunders; pp. 547-50
  16. Razmus, I. S., Dalton, M. E. & Wilson, D. (2004). Pain management for newborn circumcision. Pediatr Nurs, 30, 414-427
  17. Riley, J. L 3rd, Robinson, M. E., Wise, E. A., Myers, C. D. & Fillingim, R. B. (1998). Sex differences in the perception of noxious experimental stimuli: a metaanalysis. Pain. 74(2-3), 181-7 https://doi.org/10.1016/S0304-3959(97)00199-1
  18. Simons, S. H., van Dijk, M., Anand, K. S., Roofthooft, D., van Lingen, R. A., & Tibboel, D. (2003). Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med, 157(11), 1058-1064 https://doi.org/10.1001/archpedi.157.11.1058
  19. Spence, K., Gillies, D., Harrison, D., Johnston, L., & Nagy, S. (2005). A Reliable Pain Assessment Tool for Clinical Assessment in the Neonatal Intensive Care Unit. JOGNN, 34(1), 80-86 https://doi.org/10.1177/0884217504272810
  20. Stevens, B., & Gibbsins, B. (2002). Clinical utility and clinical significance in the assessment and management of pain in vulnerable infants. Clin Perinatol, 29(3), 459-468 https://doi.org/10.1016/S0095-5108(02)00016-7
  21. Stevens, B., Gibbsins, B., & Franck. (2000). Treatment of pain in neonatal intensive care unit. Pediatr Clin North Am. 47(3). 633-650 https://doi.org/10.1016/S0031-3955(05)70230-3
  22. Stevens, B., Johnston, C, Petryshen, P., & Taddio, A. (1996). The premature infants pain profile: developmental and initial validation. Clin J Pain, 12(1), 13-22 https://doi.org/10.1097/00002508-199603000-00004
  23. Stevens, B., McGrath, P., Gibbins, S., Beyene, J., Breau, L., Camfield, C, Finley, A., Franck, L., Howlett, A., McKeever, P., O'Brien, K., Ohlsson, A., & Yamada, J. (2003). Procedural pain in newborns at risk for neurological impairment. Pain, 105(1-2), 27-35 https://doi.org/10.1016/S0304-3959(03)00136-2
  24. Stewart, B., Lancaster, G., Lawson, J., Williams, K., & Daly, J. (2004). Validation of the Alder Hey Triage Pain Score. Arch Dis Child. 89(7), 625-30 https://doi.org/10.1136/adc.2003.032599
  25. Suraseranivongse, S., Santawat, U., Kraiprasit, K., Petcharatana, S., Prakkamodom, S., & Muntraporn, N. (2001). Cross-validation of a composite pain scale for preschool children within 24 hours of surgery. Br J Anaesth. 87(3). 400-5 https://doi.org/10.1093/bja/87.3.400
  26. Voepel-Lewis, T., Merkel, S., Tait, A. R., Trzcinka, A., & Malviya, S. (2002). The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg, 95, 1224-1229 https://doi.org/10.1097/00000539-200211000-00020
  27. White-Traut, R. C, Nelson, M. N., Silvestri, J. M., Patel, M., Berbaum, M., Gu, G. G., & Rey, P. M. (2004). Developmental patterns of physiological response to a multisensory intervention in extremely premature and high-risk infants. JOGNN, 33(2), 266-275 https://doi.org/10.1177/0884217504263289