Pain management

Just like adults and older children, preterm born babies can experience pain and it can be harmful to their developing brain. Therefore, every possible effort should be made to keep preterm babies pain free. Usually, pain results as a response to an acute stimulus that is likely to lead to injury or tissue damage. With respect to this, pain is an important signal and a vital mechanism to protect humans from possible further damage.

Every individual experiences pain in a different way and pain perception can change throughout life, for example because of different experiences during childhood.

Feeling pain means that the brain creates the perception of pain by using a complex system of nerves and receptors in the skin, muscles, bones, and organs, and their connections to the spinal cord and the brain. The message of pain is transferred from the pain receptors in the skin and tissue of the body part to the brain and back again to trigger a reaction to the stimulus.

Many other types of messages, such as touch or temperature, are also transferred in this way which is important in terms of pain relief because they actually compete with each other. Various procedures have been developed which can help relieve the pain in preterm babies.

There are two general types of pain depending on how long pain lasts. Acute pain is short-term, whereas chronic pain lasts for a longer period of time. However, these types are not mutually exclusive. Acute pain, especially if not properly addressed and treated, can also become chronic pain. Given that pain is a mind and body experience, emotional and physical interventions can be considered for assessment and relief of pain.

Many preterm or ill born babies in the neonatal intensive care unit undergo one or more painful diagnostic and therapeutic procedures, e.g., blood sampling or surgery. When preparing for certain procedures, healthcare professionals know in advance that pain is going to occur. This allows them to use pain relief measures before the painful procedure starts.

There are different strategies available for healthcare professionals to manage pain and stress in newborns including observational tools, pharmacological and non-pharmacological approaches.Observational tools are mainly so called pain scales for the assessment of signs of stress and pain before, during and after an activity to react appropriately according to the stress or pain level of the baby. These tools are also used for education and training of pain or stress behaviour.

If the pain or stress level is on a low or moderate level, healthcare professionals might use a non-pharmacological approach to comfort the baby. This may include the reduction of stressful environmental factors (e.g. light and noise), skin-to-skin care, breastfeeding, providing glucose (a form of sugar) to the baby, giving the baby a pacifier to suck, gently touching or holding the baby, and speaking to the baby. The presence of parents can be helpful and supporting for the baby during and after a painful procedure.

If needed, the care team will decide to give pain-reducing drugs (analgesics) to the baby. These can be administered in different ways, e.g. via an intravenous line or a tube. Analgesics can be given long-term or as a single dose.