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Do observational scores give a true assessment of pain during procedures on newborn infants or do we need more objective assessments of what is happening inside the infants' brains? Researchers in London (Lancet 2010;376:1225–32; see also Comment, ibid:1201–3) carried out a randomised controlled trial of sucrose versus sterile water in 59 newborn infants undergoing clinically indicated heel stabs. They assessed pain by a behavioural score (the premature infant pain profile) and by neurophysiological measures (EEG and electromyography (EMG)). The infants were born at 37–43 weeks gestation and were less than 8 days old. Pain-specific brain activity after a time-locked heel stab was recorded on EEG and identified by principal component analysis. Spinal nociceptive reflex withdrawal activity was assessed by EMG at the ipsilateral biceps femoris muscle. The EEG and EMG responses were not significantly different in the two groups but sucrose suppressed behavioural responses. These researchers suggest that scores based on observed behavioural responses may not give a true indication of pain and pain relief and that sucrose might not be an effective analgesic. The writers of the Comment article, however, question the sample size, the adequacy of the technology, and the …

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