Neonatal pain assessment and non-pharmacological analgesia: an integrative literature review.

BACKGROUND

Neonatal procedural and prolonged pain remains a frequent and clinically important problem in neonatal care, particularly among preterm and critically ill infants who undergo repeated invasive procedures.

OBJECTIVE

To synthesize evidence on neonatal pain assessment tools and non-pharmacological analgesic strategies, with attention to clinical implementation and emerging objective or digital assessment approaches.

METHODS

PubMed, CINAHL, MEDLINE, the Cochrane Library, Web of Science, Scopus, and Embase were searched for peer-reviewed English-language articles published from January 2000 to May 2025. Eligible studies included primary research, high-quality secondary evidence, and clinically relevant methodological or technological studies involving preterm or term neonates, defined as infants with a birth age of ≤28 days, or infants cared for in neonatal intensive care units. Studies were included if they addressed the development, validation, or clinical application of neonatal pain assessment tools, or the efficacy, safety, or implementation of non-pharmacological analgesic interventions. Studies limited to pharmacological analgesia, older children, or adults were excluded.

RESULTS

Thirty-five studies were included. The evidence supports the use of validated multidimensional assessment tools for structured evaluation of neonatal pain. It indicates that family-integrated, sensory, and behavioral non-pharmacological approaches can reduce procedural pain responses. However, the strength and consistency of evidence are greater for single procedures than for repeated or prolonged pain. Artificial intelligence-based facial expression analysis, physiological monitoring, and biomarker-based approaches show potential for more objective pain detection but remain insufficiently validated for routine bedside decision-making.

CONCLUSION

Standardized neonatal pain management should combine validated assessment scales, protocolized first-line non-pharmacological care, staff training, and parent involvement. Future research should prioritize repeated and prolonged pain, high-risk neonatal populations, implementation in routine neonatal intensive care practice, and the prospective validation of digital assessment systems in real-world clinical settings.