• Eva Cignacco, Jan P H Hamers, Lilian Stoffel, Richard A van Lingen, Peter Gessler, Jane McDougall, and Mathias Nelle.
• Department for Obstetrics and Neonatology, Women's and Children's Clinic, University Hospital Insel, Bern, Effingerstr. 102, CH-3010 Bern, Switzerland. eva.cignacco@insel.ch
• Eur J Pain. 2007 Feb 1;11(2):139-52.

BackgroundNeonates in a neonatal intensive care unit are exposed to a high number of painful procedures. Since repeated and sustained pain can have consequences for the neurological and behaviour-oriented development of the newborn, the greatest attention needs to be paid to systematic pain management in neonatology. Non-pharmacological treatment methods are being increasingly discussed with regard to pain prevention and relief either alone or in combination with pharmacological treatment.AimsTo identify effective non-pharmacological interventions with regard to procedural pain in neonates.MethodsA literature search was conducted via the MedLine, CINAHL, Cochrane Library databases and complemented by a handsearch. The literature search covered the period from 1984 to 2004. Data were extracted according to pre-defined criteria by two independent reviewers and methodological quality was assessed.Results13 randomised controlled studies and two meta-analyses were taken into consideration with regard to the question of current nursing practice of non-pharmacological pain management methods. The selected interventions were "non-nutritive sucking", "music", "swaddling", "positioning", "olfactory and multisensorial stimulation", "kangaroo care" and "maternal touch". There is evidence that the methods of "non-nutritive sucking", "swaddling" and "facilitated tucking" do have a pain-alleviating effect on neonates.ConclusionsSome of the non-pharmacological interventions have an evident favourable effect on pulse rate, respiration and oxygen saturation, on the reduction of motor activity, and on the excitation states after invasive measures. However, unambiguous evidence of this still remains to be presented. Further research should emphasise the use of validated pain assessment instruments for the evaluation of the pain-alleviating effect of non-pharmacological interventions.

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