The pain perception of infant

doi:10.3724/SP.J.1042.2020.01723

Abstract

Abstract:

Pain perception in infants is of great significance to the growth and development of infants, which has aroused increasing interests of researchers. Pain is essentially an unpleasant sensory and emotional experience that is acquired through early injury-related experiences. From the perspective of psychology, it is meaningful to systematically demonstrate the effects of pain perception on infant growth and development on the basis of understanding the concept of infant pain, its neurophysiological mechanism and evaluation tools. Subsequent research should continue to improve the measurement tools of pain perception in infants, and to investigate the differences in pain responses among different cultures and groups.

Key words: infant pain, brain development, pain evaluation

CLC Number:

B844

LIU Huichen, CHEN Jian. The pain perception of infant[J]. Advances in Psychological Science, 2020, 28(10): 1723-1732.

Figures/Tables 1

References 79

[1]	毕小宝, 张永福. (2014). 浅谈小儿术后镇痛现状. 2014年全国小儿麻醉学术年会暨浙江省麻醉学学术年会.
[2]	陈敏. (2015). 6个月内婴儿不明原因哭闹的危险因素研究. 医学信息, (18), 156-156.
[3]	陈明. (2015). 针对性护理干预减轻婴幼儿预防接种注射疼痛的效果观察. 基层医学论坛, (18), 2547-2548.
[4]	陈睿. (2015). 多变量模式分析在痛觉测量中的应用(硕士学位论文). 西南大学, 重庆.
[5]	程国强, 邵肖梅. (2009). 近红外光谱分析技术在新生儿脑损伤监护中的意义. 中华儿科杂志, 47(7), 554-555.
[6]	程小林. (2017). 浅论对新生儿疼痛评估方法的研究进展. 当代医药论丛, 15(18), 17-18.
[7]	丁文龙, 刘学政. (2018). 系统解剖学. 北京: 人民卫生出版社.
[8]	郭晓琴. (2015). 产后早期家庭照顾者认知与行为对新生儿母乳喂养影响的相关性研究. 全科护理, (11), 1048-1050.
[9]	侯新琳, 周丛乐, 黄岚, 丁海曙, 王红梅. (2006). 早产儿脑反应性及其神经发育的近红外光谱评价研究. 中华儿科杂志, 44(6), 445-449.
[10]	江艳. (2018). 不同干预方法减轻婴幼儿预防接种注射疼痛的效果评价. 实用临床护理学电子杂志, 3(16), 106-107.
[11]	李怀虎. (2008). 时间信息对痛觉的影响(硕士学位论文). 西南大学, 重庆.
[12]	李雪芬. (2014). 新生儿足跟采血时疼痛评估及干预进展. 现代临床护理, (4), 82-86.
[13]	林崇德. (2009). 发展心理学. 北京: 人民教育出版社.
[14]	彭聃龄. (2012). 普通心理学. 北京: 北京师范大学出版社.
[15]	苏琳, 杨周, Todd, Jackson, 陈红, 黄承志. (2016). 疼痛恐惧的形成及其对疼痛知觉的影响. 心理科学进展, 24(8), 1228-1236. doi: 10.3724/SP.J.1042.2016.01228 URL
[16]	孙长江. (2013). 基于局部二值模式和稀疏表示的新生儿疼痛表情识别(硕士学位论文). 南京邮电大学.
[17]	孙晶尧, 宋弋, 谢晓非. (2013). 不公平感影响疼痛知觉. 心理学与创新能力提升——第十六届全国心理学学术会议论文集.
[18]	童基均. (2008). 基于EEG与fMRI的痛觉机制与针灸镇痛研究(博士学位论文). 浙江大学, 杭州.
[19]	王飞宇, 吴松涛, 王璟. (2013). 疼痛与大脑活动的关系:基于脑电图的研究. 中国疼痛医学杂志, 19(7), 420-424.
[20]	周明月, 刘俊山. (2018). 婴幼儿气质类型影响因素研究进展. 安徽预防医学杂志, 24(1), 44-46.
[21]	Allen, L. B., Lu, Q., Tsao, J. C., Worthman, C. M., & Zeltzer, L. K. (2009). Sex differences in the association between cortisol concentrations and laboratory pain responses in healthy children. Gender Medicine, 6, 193-193. doi: 10.1016/j.genm.2009.03.001 URL pmid: 19406369
[22]	Atkinson, N. H., Gennis, H., Racine, N. M., & Riddell, R. P. (2015). Caregiver emotional availability, caregiver soothing behaviors, and infant pain during immunization. Journal of Pediatric Psychology, 40(10), 1105-1114. doi: 10.1093/jpepsy/jsv067 URL pmid: 26188051
[23]	Ballantyne, M., Stevens, B., Mcallister, M., Dionne, K., & Jack, A. (1999). Validation of the premature infant pain profile in the clinical setting. Clinical Journal of Pain, 15(4), 297-303. URL pmid: 10617258
[24]	Bartocci, M., Bergqvist, L. L., Lagercrantz, H., & Anand, K. J. S. (2006). Pain activates cortical areas in the preterm newborn brain. Pain, 122(1-2), 109-117. doi: 10.1016/j.pain.2006.01.015 URL pmid: 16530965
[25]	Bellieni, C. V., Tei, M., & Buonocore, G. (2015). Should we assess pain in newborn infants using a scoring system or just a detection method? Acta Paediatrica, 104(3), 221-224. URL pmid: 25429731
[26]	Benoit, B., Martin-Misener, R., Newman, A., Latimer, M., & Campbell-Yeo, M. (2017). Neurophysiological assessment of acute pain in infants: A scoping review of research methods. Acta Paediatrica, 106(7), 1053-1066. doi: 10.1111/apa.13839 URL pmid: 28326623
[27]	Berducci, D. F. (2016). Infants’ pain cries: Natural resources for co-creating a proto-interaction order. Theory & Psychology, 26(4), 438-458.
[28]	Blauer, T., & Gerstmann, D. (1998). A simultaneous comparison of three neonatal pain scales during common nicu procedures. Clinical Journal of Pain, 14(1), 39-47. doi: 10.1097/00002508-199803000-00006 URL pmid: 9535312
[29]	Blencowe, H., Cousens, S., Oestergaard, M. Z., Chou, D., Moller, A.-B., Narwal, R., … Lawn, J. E. (2012). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications. The Lancet, 379(9832), 2162-2172. doi: 10.1016/S0140-6736(12)60820-4 URL
[30]	Brummelte, S., Grunau, R. E., Chau, V., Poskitt, K. J., Brant, R., Vinall, J., ... Miller, S. P. (2012). Procedural pain and brain development in premature newborns. Annals of Neurology, 71(3), 385-396. doi: 10.1002/ana.22267 URL
[31]	Caes, L., Vervoort, T., Eccleston, C., Vandenhende, M., & Goubert, L. (2011). Parental catastrophizing about child's pain and its relationship with activity restriction: The mediating role of parental distress. Pain, 152(1), 212-222. doi: 10.1016/j.pain.2010.10.037 URL
[32]	Cassidy, J. (1994). The development of emotion regulation: Biological and behavioral considerations, emotion regulation: Influences of attachment relationships. Monographs of the Society for Research in Child Development, 59, 228-249. URL pmid: 7984163
[33]	Chen, X., & Schmidt, L. A. (2015). Temperament and Personality. In L. A. Schmidt (Eds.), Lecture notes in Handbook of Child Psychology and Developmental Science: Vol. 3: Socioemotional Processes(pp. 1-49). Hoboken, NJ: Wiley.
[34]	Chen, Y, -C., Auer-Grumbach, M., Matsukawa, S., Zitzelsberger, M., Themistocleous, A. C., Strom, T. M., … Senderek, J. (2015). Transcriptional regulator PRDM12 is essential for human pain perception. Nature genetics, 47(7), 803-808. doi: 10.1038/ng.3308 URL pmid: 26005867
[35]	Cignacco, E., Mueller, R., Hamers, J. P. H., & Gessler, P. (2004). Pain assessment in the neonate using the bernese pain scale for neonates. Early Human Development, 78(2), 125-131. URL pmid: 15223117
[36]	Committee On Fetus, Newborn, & Section On Anesthesiology and Pain Medicine. (2016). Prevention and management of procedural pain in the neonate: An update. Pediatrics, 137(2), 1-13. doi: 10.1542/peds.2015-4450 URL
[37]	Cox, J. J., Reimann, F., Nicholas, A. K., Thornton, G., Roberts, E., Springell, K., ... Woods, C. G. (2006). An SCN9A channelopathy causes congenital inability to experience pain. Nature, 444(7121), 894-898. URL pmid: 17167479
[38]	Debillon, T., Zupan, V., Ravault, N., Magny, J. F., & Dehan, M. (2001). Development and initial validation of the edin scale, a new tool for assessing prolonged pain in preterm infants. Archives of Disease in Childhood - Fetal and Neonatal Edition, 85(1), 36-41.
[39]	Decchi, B., Zalaffi, A., Spidalieri, R., Arrigucci, U., Di Troia, A. M., & Rossi, A. (1997). Spinal reflex pattern to foot nociceptive stimulation in standing humans. Electroencephalography and Clinical Neurophysiology, 105(6), 484-489. doi: 10.1016/s0924-980x(97)00048-9 URL pmid: 9448651
[40]	Fabrizi, L., Slater, R., Worley, A., Meek, J., Boyd, S., Olhede, S., & Fitzgerald, M. (2011). A shift in sensory processing that enables the developing human brain to discriminate touch from pain. Current Biology, 21(18), 1552-1558. doi: 10.1016/j.cub.2011.08.010 URL pmid: 21906948
[41]	Fitzgerald, M., & Walker, S. M. (2009). Infant pain management: A developmental neurobiological approach. Nature, 5(1), 35-50. doi: 10.1038/005035a0 URL
[42]	Franck, L. S., Greenberg, C. S., & Stevens, B. (2000). Pain assessment in infants and children. Pediatric Clinics of North America, 47(3), 487-512. URL pmid: 10835987
[43]	Gartstein, M. A., Slobodskaya, H. R., & Kinsht, I. A. (2003). Cross-cultural differences in temperament in the first year of life: United states of america (us) and russia. International Journal of Behavioral Development, 27(4), 316-328. doi: 10.1080/01650250244000344 URL
[44]	Goksan, S., Baxter, L., Moultrie, F., Duff, E., Hathway, G., Hartley, C., ... Slater, R. (2018). The influence of the descending pain modulatory system on infant pain-related brain activity. ELife, 7, e37125. doi: 10.7554/eLife.37125 URL pmid: 30201093
[45]	Goksan, S., Hartley, C., Emery, F., Cockrill, N., Poorun, R., Moultrie, F., ... Slater, R. (2015). FMRI reveals neural activity overlap between adult and infant pain. ELife, 4, e06356. doi: 10.7554/eLife.06356 URL
[46]	Grunau, R. E., Oberlander, T., Holsti, L., & Whitfield, M. F. (1998). Bedside application of the neonatal facial coding system in pain assessment of premature infants. Pain, 76(3), 277-286. doi: 10.1016/s0304-3959(98)00046-3 URL pmid: 9718246
[47]	Guinsburg, R., de Araújo Peres, C., de Almeida, M. F. B., de Cássia Xavier Balda, R., Berenguel, R. C., Tonelotto, J., & Kopelman, B. I. (2000). Differences in pain expression between male and female newborn infants. Pain, 85(1-2), 127-133. URL pmid: 10692611
[48]	Hartley, C., Duff, E. P., Green, G., Mellado, G. S., Worley, A., Rogers, R., & Slater, R. (2017). Nociceptive brain activity as a measure of analgesic efficacy in infants. Science Translational Medicine, 9(388), 1-10.
[49]	Hartley, C., Goksan, S., Poorun, R., Brotherhood, K., Mellado, G. S., Moultrie, F., ... Slater, R. (2015). The relationship between nociceptive brain activity, spinal reflex withdrawal and behaviour in newborn infants. Scientific Reports, 5(1), 12519. doi: 10.1038/srep12519 URL
[50]	Hartley, C., & Slater, R. (2014). Neurophysiological measures of nociceptive brain activity in the newborn infant - the next steps. Acta Paediatrica, 103(3), 238-242. URL pmid: 24180281
[51]	Hodgkinson, K., Bear, M., Thorn, J., & van Blaricum, S. (1994). Measuring pain in neonates: Evaluating an instrument and developing a common language. The Australian Journal of Advanced Nursing, 12(1), 17-22. URL pmid: 7786451
[52]	Horton, R. E., Riddell, R. P., Flora, D., Moran, G., & Pederson, D. (2015). Distress regulation in infancy: Attachment and temperament in the context of acute pain. Journal of Developmental & Behavioral Pediatrics, 36(1), 35-44. doi: 10.1097/DBP.0000000000000119 URL pmid: 25539090
[53]	Hummel, P., Lawlor-Klean, P., & Weiss, M. G. (2010). Validity and reliability of the n-pass assessment tool with acute pain. Journal of Perinatology, 30(7), 474-478. URL pmid: 19924132
[54]	Hummel, P., Puchalski, M., Creech, S. D., & Weiss, M. G. (2008). Clinical reliability and validity of the n-pass: Neonatal pain, Agitation and sedation scale with prolonged pain. Journal of Perinatology, 28(1), 55-60. doi: 10.1038/sj.jp.7211861 URL pmid: 18165830
[55]	Krechel, S. W., & Bildner, J. (1995). Cries: A new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatric Anaesthesia, 5(1), 53-61. doi: 10.1111/j.1460-9592.1995.tb00242.x URL pmid: 8521311
[56]	Laura, C., Lorenzo, F., Deborah, P., Alan, W., Judith, M., Stewart, B., ... Maria, F. (2013). Postnatal temporal, Spatial and modality tuning of nociceptive cutaneous flexion reflexes in human infants. PLoS One, 8(10), 76470.
[57]	Lawrence, J., Alcock, D., Mcgrath, P. J., Kay, J., MacMurray, S. B., & Dulberg, C. (1993). The development of a tool to assess neonatal pain (nips). Neonatal Network, 12(6), 59-66. URL pmid: 8413140
[58]	Liao, S.-C., Chou, W., Lin, J.-H., Chen, P.-Y., & Chow, J. C. (2018). Investigation of the early prediction of infants’ temperament based on infant cries evoked by external pain stimuli. Early Child Development and Care, 10, 1-13. doi: 10.1080/0300443820100101 URL
[59]	Malviya, S., Voepel-lewis, T., Burke, C., Merkel, S., & Tait, A. R. (2006). The revised flacc observational pain tool: Improved reliability and validity for pain assessment in children with cognitive impairment. Pediatric Anesthesia, 16(3), 258-265. URL pmid: 16490089
[60]	Mathew, P., & Mathew, J. L. (2003). Assessment and management of pain in infants. Postgraduate Medical Journal, 79(934), 438-443. doi: 10.1136/pmj.79.934.438 URL pmid: 12954954
[61]	Pabis, E., Kowalczyk, M., & Kulik, T. B. (2010). Pain in children in historical perspective. Anestezjologia Intensywna Terapia, 42(1), 37-41. URL pmid: 20608214
[62]	Pasero, C. (2002). Pain assessment in infants and young children: Premature infant pain profile. American Journal of Nursing, 102(9), 105-106. doi: 10.1097/00000446-200209000-00065 URL pmid: 12394025
[63]	Polkki, T., Korhonen, A., Axelin, A., Saarela, T., & Laukkala, H. (2014). Development and preliminary validation of the neonatal infant acute pain assessment scale (niapas). International Journal of Nursing Studies, 51(12), 1585-1594. doi: 10.1016/j.ijnurstu.2014.04.001 URL pmid: 24815773
[64]	Riddell, R. P., Campbell, L., Flora, D. B., Racine, N., Osmun, L. D., Garfield, H., & Greenberg, S. (2011). The relationship between caregiver sensitivity and infant pain behaviors across the first year of life. Pain, 152(12), 2819-2826. URL pmid: 22000098
[65]	Rodkey, E. N., & Riddell, R. P. (2013). The infancy of infant pain research: The experimental origins of infant pain denial. The Journal of Pain, 14(4), 338-350. doi: 10.1016/j.jpain.2012.12.017 URL pmid: 23548489
[66]	Schechter, N. L., Allen, D. A., & Hanson, K. (1986). Status of pediatric pain control: A comparison of hospital analgesic usage in children and adults. Pediatrics, 77(1), 11-15. URL pmid: 2415909
[67]	Slater, R., Worley, A., Fabrizi, L., Roberts, S., Meek, J., Boyd, S., & Fitzgerald, M. (2010). Evoked potentials generated by noxious stimulation in the human infant brain. European Journal of Pain, 14(3), 321-326. URL pmid: 19481484
[68]	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. The Journal of Obstetric, Gynecologic, & Neonatal Nursing, 34(1), 80-86. doi: 10.1177/0884217504272810 URL pmid: 15673649
[69]	Stevens, B., Johnston, C., Petryshen, P., & Taddio, A. (1996). Premature infant pain profile: Development and initial validation. Clinical Journal of Pain, 12(1), 13-22. URL pmid: 8722730
[70]	Stevens, B. J., Gibbins, S., Yamada, J., Dionne, K., Lee, G., Johnston, C., & Taddio, A. (2014). The Premature Infant Pain Profile-Revised (PIPP-R): Initial validation and feasibility. Clinical Journal of Pain, 30(3), 238-243. doi: 10.1097/AJP.0b013e3182906aed URL
[71]	Suraseranivongse, S., Kaosaard, R., Intakong, P., Pornsiriprasert, S., Karnchana, Y., Kaopinpruck, J., & Sangjeen, K. (2006). A comparison of postoperative pain scales in neonates. British Journal of Anaesthesia, 97(4), 540-544. URL pmid: 16885171
[72]	Tracey, I., & Mantyh, P. W. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55(3), 377-391. doi: 10.1016/j.neuron.2007.07.012 URL
[73]	Valeri, B. O., Holsti, L., & Linhares, M. B. (2015). Neonatal pain and developmental outcomes in children born preterm: A systematic review. Clinical Journal of Pain, 31(4), 355-362. doi: 10.1097/AJP.0000000000000114 URL pmid: 24866853
[74]	Vandam, L. D. (1985). A calculus of suffering. Pain, Professionalism, And anesthesia in nineteenth century America. Anesthesia & Analgesia, 64(12), 1229. doi: 10.1111/ana.2009.64.issue-11 URL
[75]	Vaughan Van Hecke, A., Mundy, P., Block, J. J., Delgado, C. E. F., Parlade, M. V., Pomares, Y. B., & Hobson, J. A. (2012). Infant responding to joint attention, executive processes, and self-regulation in preschool children. Infant Behavior & Development, 35(2), 303-311. URL pmid: 22206892
[76]	Vinall, J., & Grunau, R. E. (2014). Impact of repeated procedural pain-related stress in infants born very preterm. Pediatric Research, 75(5), 584-587. doi: 10.1038/pr.2014.16 URL pmid: 24500615
[77]	Vinall, J., Riddell, R. P., & Greenberg, S. (2011). The influence of culture on maternal soothing behaviours and infant pain expression in the immunization context. Pain Research and Management, 16(4), 234-238. URL pmid: 22059192
[78]	Warnock, F. F., Craig, K. D., Bakeman, R., & Castral, T. (2014). Self-regulation (recovery) from pain: Association between time-based measures of infant pain behavior and prenatal exposure to maternal depression and anxiety. Clinical Journal of Pain, 30(8), 663-671. doi: 10.1097/AJP.0000000000000002 URL pmid: 24042350
[79]	Worley, A., Fabrizi, L., Boyd, S., & Slater, R. (2012). Multi-modal pain measurements in infants. Journal of Neuroscience Methods, 205(2), 252-257. URL pmid: 22285660

量表名称	适用对象	测量指标	计分标准	信效度	优缺点
疼痛评估工具(PAT)	危重症患儿(使用肌肉松弛剂的患儿除外)	生理指标：心率、血氧饱和度、呼吸、血压; 行为指标：体位、肌张力、睡眠型态、面部表情、肤色、哭声	每项从1分(最差)到3分(最佳)计分, 共计4~12分, 分数越高表示痛感越强	信效度良好	包括护士对新生儿疼痛的感知, 这是其他测量方法没有涉及到的
新生儿使用量表(SUN)	早产儿、足月儿	生理指标：中枢神经系统、呼吸、心率、血压; 行为指标：面部表情、四肢活动度、肌张力	分数越高表示痛感越强	改进了疼痛评估的计分设计, 具有一定的有效性和可靠性	评估相似的行为和生理变量时对比其他评估工具具有更好的易用性和规模的对称性, 但使用难度较大
新生儿疼痛与不适量表(EDIN)	0~5岁儿童持续性疼痛	面部表情、肢体活动、睡眠质量、可安慰程度	每个条目包含4种行为描述, 分别赋予0, 1, 2, 3分, 总分15分。由儿童的监护人填写。得分0分代表无任何疼痛或不适; 得分15分代表严重疼痛与不适	评分者信度0.59~0.74, 内部一致性系数0.86~ 0.94, 内容效度较好	可测量婴幼儿的持续性疼痛, 具有更高的临床实用性, 但部分条目不适合评估早产儿与镇静患儿, 或易受主观因素的影响
新生儿术后疼痛评估工具(CRIES)	32周以上的新生儿术后疼痛	生理指标：心率、血氧饱和度; 行为指标：哭声、面部表情、睡眠情况	每项评分0~2分, 总分0~10分, >3分需要镇痛, 4~6分为中度疼痛, 7~10分为重度疼痛	信效度良好	有较强的实用性和可靠性, 但在评估新生儿术后疼痛时对血氧饱和度>95%所需氧浓度以及生命体征升高的情况无法解释
新生儿疼痛、烦躁、镇静评估量(N-PASS)	早产儿、足月儿	生理指标：心率、血氧饱和度、呼吸形态、血压; 行为指标：哭声、易怒、行为状态、四肢肌张力	每项评分0~2分, 总分0~10分; 镇静评分通常用于使用镇静药物的患儿, 每项标准为-2~0分, 总分为-10~0分。疼痛得分>2分和镇静得分<-2分均需要进行干预	评分者信度0.85~0.95, 内部一致性系数0.82~ 0.87, 结构效度较好	可单独评估每一项, 但很难对疼痛与激动进行区分
新生儿急性疼痛评估量表(NIAPAS)	机械通气患儿	5项行为指标(警觉性、面部表情、哭闹、肌张力、对操作的反应)、3项生理性指标(呼吸、心率、氧饱和度)及一个相关因素(孕周)	总分0~18分, 0~5分表示没有疼痛或轻度疼痛, 可根据情况考虑非药物干预; 6~9分为中度疼痛, 需进行非药物干预, 并考虑药物干预; ≥10分为重度疼痛, 需要非药物和药物的共同干预	评分者信度0.991~0.997, 内部一致性系数0.732, 内容效度指数1.0, 结构效度也较好	是一个准确评估NICU患儿疼痛的多维性评估工具, 具有较高的临床实用性
新生儿疼痛量表(NIPS)	28~38周新生儿	生理指标：呼吸型态; 行为指标：面部表情、哭声、四肢活动、觉醒状态	总分0~7分, 4分为临界值	信效度良好	内容较为简便, 临床适用性较强
新生儿疼痛评估(PAIN)	新生儿	面部表情、哭声、呼吸模式、肢体运动、唤醒状态、维持饱和度所需的氧含量(95%), 以及生命体征的增加, 心率	每项评分0~2分。总分0~10分, 得分越高说明疼痛越严重	仅通过NIPS测试, 没有迹象表明可靠性	评估新生儿疼痛时使用广泛
早产儿疼痛量表(PIPP)	早产儿、足月儿	2个基线指标(行为状态、胎龄)、2个生理指标(血氧饱和度、心率)、3个行为指标(皱眉、挤眼、鼻唇沟加深)	每个项目指标采用4分制, 总分最高18分(足月儿)或21分(早产儿), 6分为临界值。6分或以下通常表示轻微或没有疼痛, 高于12分表示中度或重度疼痛	评分者信度0.95; 用于确定可行性的标准没有具体说明	用于测量急性和持续性疼痛, 在评估长期、持续和慢性疼痛方面的临床应用和可行性上研究有限
儿童疼痛行为量表(FLACC)	2个月~7岁的儿童	表情、肢体运动、活动、哭泣、可安慰性	每项评分0~2分, 总分最低为0分, 最高为10分, 1~3分为轻度疼痛, 4~6分为中度疼痛, 7~10分为重度疼痛, 得分越高说明患儿的疼痛和不适感越明显。	量表内部一致性系数0.853, 具有较好的稳定性和可靠性	可作为我国学龄前儿童术后疼痛评估的有效工具, 从而为临床镇痛药物和技术的使用提供可靠依据
Bernes 疼痛评估量表(BPSN)	早产儿、足月儿、极低出生体重儿	生理指标：心率、呼吸、血压、血氧饱和度; 行为指标：面部表情、体位、四肢活动、警觉性	分数越高表示痛感越强	信效度良好	可用于评价急性疼痛

量表名称	适用对象	测量指标	计分标准	信效度	优缺点
疼痛评估工具(PAT)	危重症患儿(使用肌肉松弛剂的患儿除外)	生理指标：心率、血氧饱和度、呼吸、血压; 行为指标：体位、肌张力、睡眠型态、面部表情、肤色、哭声	每项从1分(最差)到3分(最佳)计分, 共计4~12分, 分数越高表示痛感越强	信效度良好	包括护士对新生儿疼痛的感知, 这是其他测量方法没有涉及到的
新生儿使用量表(SUN)	早产儿、足月儿	生理指标：中枢神经系统、呼吸、心率、血压; 行为指标：面部表情、四肢活动度、肌张力	分数越高表示痛感越强	改进了疼痛评估的计分设计, 具有一定的有效性和可靠性	评估相似的行为和生理变量时对比其他评估工具具有更好的易用性和规模的对称性, 但使用难度较大
新生儿疼痛与不适量表(EDIN)	0~5岁儿童持续性疼痛	面部表情、肢体活动、睡眠质量、可安慰程度	每个条目包含4种行为描述, 分别赋予0, 1, 2, 3分, 总分15分。由儿童的监护人填写。得分0分代表无任何疼痛或不适; 得分15分代表严重疼痛与不适	评分者信度0.59~0.74, 内部一致性系数0.86~ 0.94, 内容效度较好	可测量婴幼儿的持续性疼痛, 具有更高的临床实用性, 但部分条目不适合评估早产儿与镇静患儿, 或易受主观因素的影响
新生儿术后疼痛评估工具(CRIES)	32周以上的新生儿术后疼痛	生理指标：心率、血氧饱和度; 行为指标：哭声、面部表情、睡眠情况	每项评分0~2分, 总分0~10分, >3分需要镇痛, 4~6分为中度疼痛, 7~10分为重度疼痛	信效度良好	有较强的实用性和可靠性, 但在评估新生儿术后疼痛时对血氧饱和度>95%所需氧浓度以及生命体征升高的情况无法解释
新生儿疼痛、烦躁、镇静评估量(N-PASS)	早产儿、足月儿	生理指标：心率、血氧饱和度、呼吸形态、血压; 行为指标：哭声、易怒、行为状态、四肢肌张力	每项评分0~2分, 总分0~10分; 镇静评分通常用于使用镇静药物的患儿, 每项标准为-2~0分, 总分为-10~0分。疼痛得分>2分和镇静得分<-2分均需要进行干预	评分者信度0.85~0.95, 内部一致性系数0.82~ 0.87, 结构效度较好	可单独评估每一项, 但很难对疼痛与激动进行区分
新生儿急性疼痛评估量表(NIAPAS)	机械通气患儿	5项行为指标(警觉性、面部表情、哭闹、肌张力、对操作的反应)、3项生理性指标(呼吸、心率、氧饱和度)及一个相关因素(孕周)	总分0~18分, 0~5分表示没有疼痛或轻度疼痛, 可根据情况考虑非药物干预; 6~9分为中度疼痛, 需进行非药物干预, 并考虑药物干预; ≥10分为重度疼痛, 需要非药物和药物的共同干预	评分者信度0.991~0.997, 内部一致性系数0.732, 内容效度指数1.0, 结构效度也较好	是一个准确评估NICU患儿疼痛的多维性评估工具, 具有较高的临床实用性
新生儿疼痛量表(NIPS)	28~38周新生儿	生理指标：呼吸型态; 行为指标：面部表情、哭声、四肢活动、觉醒状态	总分0~7分, 4分为临界值	信效度良好	内容较为简便, 临床适用性较强
新生儿疼痛评估(PAIN)	新生儿	面部表情、哭声、呼吸模式、肢体运动、唤醒状态、维持饱和度所需的氧含量(95%), 以及生命体征的增加, 心率	每项评分0~2分。总分0~10分, 得分越高说明疼痛越严重	仅通过NIPS测试, 没有迹象表明可靠性	评估新生儿疼痛时使用广泛
早产儿疼痛量表(PIPP)	早产儿、足月儿	2个基线指标(行为状态、胎龄)、2个生理指标(血氧饱和度、心率)、3个行为指标(皱眉、挤眼、鼻唇沟加深)	每个项目指标采用4分制, 总分最高18分(足月儿)或21分(早产儿), 6分为临界值。6分或以下通常表示轻微或没有疼痛, 高于12分表示中度或重度疼痛	评分者信度0.95; 用于确定可行性的标准没有具体说明	用于测量急性和持续性疼痛, 在评估长期、持续和慢性疼痛方面的临床应用和可行性上研究有限
儿童疼痛行为量表(FLACC)	2个月~7岁的儿童	表情、肢体运动、活动、哭泣、可安慰性	每项评分0~2分, 总分最低为0分, 最高为10分, 1~3分为轻度疼痛, 4~6分为中度疼痛, 7~10分为重度疼痛, 得分越高说明患儿的疼痛和不适感越明显。	量表内部一致性系数0.853, 具有较好的稳定性和可靠性	可作为我国学龄前儿童术后疼痛评估的有效工具, 从而为临床镇痛药物和技术的使用提供可靠依据
Bernes 疼痛评估量表(BPSN)	早产儿、足月儿、极低出生体重儿	生理指标：心率、呼吸、血压、血氧饱和度; 行为指标：面部表情、体位、四肢活动、警觉性	分数越高表示痛感越强	信效度良好	可用于评价急性疼痛