Detecting Pain in Infants and Non-Responsive Patients

Detecting Pain in Infants and Non-Responsive Patients

Imagine Being in Pain and Not Being Able to Ask for Help!

Detecting pain in infants can be difficult. Usually facial expression and body language can be very helpful in many situations. There are, however, scientific methods that can also be used successfully today. 

Difficulty assessing pain is also encountered with non-responsive patients, e.g. Coma, Alzheimer's, Autistic, etc. 

Anyone who cannot communicate is vulnerable to being in pain and not being able to ask for help. 

The Children and Infants Postoperative Pain Scale (ChIPPS) is one tool used for subjective assessment. It involves only observing facial expressions, listening to crying or sounds, and body language. 

Another subjective tool is the FLACC scale. Using these tools, a pain score is given from 0 to 10 using these observations. Typically, pain management is considered with a score of 4 or more. 

Medical monitoring could also be used to signal pain in infants and non-communicative patients. Heart rate and skin conductance are known measures of distress in general, one of which reasons might be pain. Oxygen Saturation and fMRI can also be used to assess pain. 

Common sense is necessary when using medical monitoring to assess pain, since these same measures are triggered by fear, excitement, handling, etc. 

Maybe someday there will be a Medical Monitor with an Emotional Stress and/or Pain Indicator. This monitor could have a color indicator to alert medical staff that something is not right with the patient. Green could mean patient is relaxed. Yellow could mean patient is becoming agitated for some reason. Red could mean patient is in severe distress or pain. Of course, a "red condition" should be alleviated as soon as possible. 

Another interesting possibility is using facial recognition software to identify people in pain. MIT, as well as others, are working on such a concept. Perhaps, medical monitoring, such as above, could be combined with facial recognition software to give a more complete portable pain analysis tool. 

Takeaways:

• Pain is difficult to assess in patients who cannot say they are in pain and where the pain is located.
• Visual and Audible observations are frequently used due to availability and previous practice.
• Medical Monitoring can also be used to indicated Emotional Stress and/or Pain, whether someone communicates it or not.
• Facial recognition software and fMRI are technologies also being researched for pain detection.

For more information:

• Pain in Babies also FLACC Scale
• Neonatal Monitoring Technologies by Wei Chen et al., IGI Global Snippet, 2012 - See "Pain Assessment in Neonates"
• Skin conductance measurements as pain assessment in newborn infants born at 22-27 weeks gestational age at different postnatal age.
• Autonomic responses to heat pain: Heart rate, skin conductance, and their relation to verbal ratings and stimulus intensity
• Heart rate, oxygen saturation, and skin conductance: A comparison study of acute pain in Brazilian newborns
• The Perfusion Index as Measured by a Pulse Oximeter Indicates Pain Stimuli in Anesthetized Volunteers
• Face recognition software could detect pain in patients
• Assessing pain in infants - New software could help medical staff know when newborn patients are in pain
• Medical Monitor with an Emotional Stress and/or Pain Indicator - an Idea Ahead of Its Time

Disclaimer - Article is for information only is not medical advice.