The effectiveness of only 10 of 43 available pain measurement instruments specific to neonates has been examined in studies deemed of poor to fair quality, according to a systematic review published in the Journal of Pain.

Investigators found 9 studies in which the effectiveness of pain measurement instruments (n=10) was studied by examining their responsiveness after pain-reducing interventions in neonates. The quality of methodology employed in each study was evaluated using Consensus-based Standards for the selection of health Measurement Instruments checklist.

Of the 9 validation studies that met inclusion criteria, 4 were deemed by the reviewers to be of poor methodologic quality and 5 were deemed to be of fair quality. Studies were considered of poor methodologic quality if they had small samples (ie, n<30; n=3), if the required statistical power for significance had not been determined before starting the study (n=2), or if sample size had been determined based on responsiveness vs interrater reliability (n=1).

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In addition, in most studies, the assessors were not, and could not reliably be, blinded to the condition (ie, before vs after pain-reducing intervention), and the methods used to alleviate pain varied widely across studies, as did time intervals between pain assessments.

Review limitations include the exclusion of studies in which clinimetric properties were not assessed.

“Because alternative methods to assess pain in clinical practice are lacking, more research on this topic is needed, with more attention to blinding and formulating a specific hypothesis before start of data collection,” noted the review authors.

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Meesters N, Dilles T, Simons S, van Dijk M. Do pain measurement instruments detect the effect of pain-reducing interventions in neonates? A systematic review on responsiveness [published online December 23, 2018]. J Pain. doi: 10.1016/j.jpain.2018.12.005