Stevens Bonnie, Gibbins Sharyn
Faculties of Nursing and Medicine, University of Toronto, Hospital for Sick Children, Toronto, ON, Canada.
Clin Perinatol. 2002 Sep;29(3):459-68. doi: 10.1016/s0095-5108(02)00016-7.
Pain in vulnerable populations unable to provide verbal report is challenging in terms of measurement and treatment. Clinicians strive to provide the best possible pain management for infants in the NICU, yet they are often hindered due to paucity of measures that are not only reliable and valid but also clinically useful. Clinical utility of measures is difficult to establish due to a lack of consistent definition of the construct, varied methods of determination, and the secondary importance afforded to this issue in relation to the establishment of reliability and utility. Without clinically useful pain measures, however, clinicians are unable and unlikely to assess the infant's pain or the effectiveness of pain-relieving interventions. Furthermore, even when the clinician is able to assess pain using a valid measure with a minimum of time, cost, and instruction, the clinical significance of any reduction in pain scores needs to be interpreted in terms of the infant and his/her care provider. The issue of defining the extent of change in pain scores that is clinically significant or important remains unclear. Clarity will involve assigning meaning to particular changes in pain scores for vulnerable infants across a broad array of situations and severities of pain. Although research on this topic in children and adults provides some guidance to this dilemma, only through innovative and creative methods will we be able to address these issues.
对于无法进行言语报告的弱势群体而言，疼痛的测量和治疗颇具挑战性。临床医生努力为新生儿重症监护病房（NICU）中的婴儿提供尽可能最佳的疼痛管理，但他们常常因缺乏不仅可靠有效且具有临床实用性的测量方法而受阻。由于对该概念缺乏一致的定义、多样的确定方法以及在确立可靠性和有效性方面此问题被赋予的次要地位，测量方法的临床实用性难以确立。然而，若没有具有临床实用性的疼痛测量方法，临床医生就无法且不太可能评估婴儿的疼痛或止痛干预措施的效果。此外，即便临床医生能够使用一种有效且耗时短、成本低、无需过多说明的测量方法来评估疼痛，疼痛评分降低的临床意义仍需依据婴儿及其护理人员来解读。疼痛评分中具有临床显著性或重要性的变化程度的定义问题仍不明确。明确这一点将涉及为处于广泛情形和不同疼痛严重程度下的脆弱婴儿的疼痛评分的特定变化赋予意义。尽管针对儿童和成人在该主题上的研究为这一困境提供了一些指导，但唯有通过创新和创造性的方法，我们才能解决这些问题。
