The evaluation and treatment of neonatal pain remain conflicting in spite of scientific evidence and agreement among practitioners that neonates do experience pain. In fact, pain forms the basis for numerous succeeding maturational events and may intervene future responses to pain. Until recently, the neonate's ability to feel pain has been the subject of debate and controversy. Although most practitioners would agree that neonates experience pain, the assessment and treatment of neonatal pain remain inconsistent. All infants in the neonatal intensive care unit (NICU) undergo potentially painful procedures on a routine basis. Decisions regarding the need for pain medication or other nonpharmacologic interventions often rest with the staff nurse caring for the neonate. Although the scientific basis for neonatal pain is growing, treatment decisions continue to be influenced by myths, subjective interpretation of physiologic and behavioral changes, the emotional component and value beliefs of practitioners regarding pain, and long-term consequences. Pain treatment with neonates is difficult because most pain assessment instruments are designed for an individual with verbal skills. Historical beliefs and myths about neonates and pain have also clouded our understanding of the phenomenon. Three myths have persisted despite new knowledge development: the belief that the infant lacks pain receptors; the belief that there is a lack of myelinization in the peripheral nerves and central nervous system, making infants incapable of pain perception; and the belief that the central nervous system of neonates is underdeveloped. (Carlson, 1996)
Untreated pain has poor physiologic consequences as well as apparent short-and long-term consequences. Difficult physiologic consequences, including blood pressure and glucose alterations, may be important enough to sway the development of intraventricular hemorrhage. Short-term effects may include feeding problems, parent-infant interaction dysfunction, and interruption of sleep-wake cycles. Conjectures regarding possible long-term effects include impairments of neurodevelopment, learning, and memory. Therefore, nurses have a societal and ethical mandate to be knowledgeable about neonatal pain and proactive in neonatal pain interventions.
