This article describes developments in pain assessment in critically ill neonates and infants during the last 5 to 6 years. Pain assessment instruments show a redundancy of items and a lack of profound psychometric background. Although most research focuses primarily on acute pain, in clinical practice there is also the challenge of assessing prolonged and/or persisting pain. The effectiveness of pain assessment is still a matter of debate and has recently been challenged as a primary end point in analgesia-related trials. Integration of observation of behavior with reliable and specific neurobiology-based parameters remains a challenge.
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Newly introduced behavioral and multidimensional pain assessment tools have limited added value because they largely overlap with existing tools.
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Although most research focuses primarily on acute pain, clinical practice also presents the challenge of assessing prolonged and/or persisting pain.
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Many institutions have not yet adopted pain assessment as the fifth vital sign. The reasons for this noncompliance have not yet been elucidated.
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The effectiveness of behavioral pain assessment is still a matter of debate and its use as primary end point in analgesia-related trials has recently been challenged.
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Pain assessment should not be implemented as a stand-alone procedure but should come with pain treatment instructions.
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