Canadian researchers explore parameters to define and assess chronic pain in infants

A team of Canadian researchers probed 45 pediatric clinicians to learn about possible indicators that could help identify infants with chronic pain and provide guidance on how to differentiate chronic pain from lingering pain caused by medical procedures.

At the outset of their study, the authors (representing several Toronto medical centers) noted there is no clear definition for chronic pain in infants and no validated assessment measures. As a result, long-term pain may be inadequately managed in this highly vulnerable population. The purpose of the research, therefore, was to gather and analyze opinions of experienced pediatric clinicians on parameters that could help define and assess chronic pain in infancy.

As expected, the interviews revealed wide ranging views on infant pain, but there was strong consensus that infants can experience chronic pain, defined as a pain phenomenon distinct from acute procedural or postoperative pain. However, varying conceptualizations were expressed by the clinicians on how chronic pain can be identified in infants. Nearly 40 percent of the clinicians interviewed believe infants who experience pain for days or weeks may be experiencing chronic pain. However, others disputed that assumption and contend that many infants in neonatal or pediatric intensive care units may have persistent pain from undergoing frequent painful medical procedures. The authors noted this debate emphasizes an urgent need to define pain states beyond what might be experienced in intensive care.

Some unique indicators did emerge from the interviews that could warrant further research. Two thirds of the clinicians maintained that an infant's reaction to a painful procedure could be a key variable for assessing chronic pain. It was suggested that an infant showing little or no reaction to a painful procedure may have chronic pain. However, chronic pain must be defined for infants, especially to differentiate it from protracted pain with a known end point, such as pain from a medical procedure.