Very interesting thought and also worth to discuss. Sometimes I think it provides us a reason to give narcotics but not necessary what the baby needs. If you are true believer about any pain is going to hurt the baby in the long run then the score will be very helpful to you. Don't we have the problem that too much narcotics are prescribed and too many patients become addicted. I a a believer that God desgn the pain for some reason as long as it is not too stressful. 

I agree that even pain has a sense; but provoking pain to a baby during a medical procedure is always a failure, and every effort should be done in order to avoid it. We have good non-pharmacological strategies and treatments to blunt pain in adults and babies; we have also good painkillers that nonetheless should be used with parsimony. But giving a score to babies' acute pain has scarce sense, because when you measure pain you have already provoked it.

At the same time, it does elp you know how well your "pain-killers" for lack of a better term are working or not working. I may be the only one speaking who is old enough to remember when no anesthesics of any kind were used with infants and children because it was believed that they did not feel, recognize or remember pain. Thankfully, we have now at least come to recognize that such is far, far from the truth! If we can find out from the response of one or more children that a particular technique is not working at diminishing their pain; OR if we can judge a particular clinician's facility with a technique (and perhaps the need for them to return for more practice to the clinical lab?), then we will have done well by our patients.

I think that in the case of provoked pain, measure tools are useful to assess the effect of the analgesic strategy that has been employed

I think good common sense will indicate when a newborn is suffering pain. This can be seen on basic clinical examination.  I think the tools can be used for training staff. Once aware it is easy to see the newborn suffering pain

I agree with dr Adhikari; I'd like to know the actual rate of NICUs or neonatology wards where scales are commonly (and not episodically) used. Of course, I'm speaking of scales used during routine heelpricks, aspirations, etcetera

In the nursing world of the United States, and in my lived experiences as a NICU and PICU nurse; pain is considered the 5th vital sign. There are variations of pain scales that exist in both clinical areas and specific to neonates vs. children. I agree with Dr.  Teng, sometimes narcotics are given to freely without critically thinking "why the baby is crying"...possibly they just are uncomfortable with their wet diaper or hungry, and for this case we would be needlessly giving an infant a narcotic without critically thinking about the context of the situation. 

http://www.ncbi.nlm.nih.gov/pubmed/24300956

http://www.ncbi.nlm.nih.gov/pubmed/21988718

Ok; but the point is if we should score pain even for minor procedures, for which most pain scales exist and are not easy to use (and give a score when the procedure is over, i.e. when it's too late to change. I argue that measuring pain is good for long-term situations (intubation, post-surgery...), but not for acute and rapid  procedure for which assessing whether pain is present or not is enough.

Dr. Bellieni, in my experiences some parents will refuse  IM shots because they believe they hurt their babies, even if it is momentarily, and the benefits outweigh the risks of a painful injection.  Applying an anesthetic cream according to the directions prior to IM shots in order to minimize the pain of the IM shot is a normal procedure if the physician or NP orders it. Assessing for pain using a pain scale prior to an acute procedure e.g. an immunization administered IM, or subcutaneously, can be a way to monitor the effects of the anesthetic cream; an anesthetic administered prior to the acute or rapid procedure of immunization. Just one example of the importance of a pain scale for an acute and rapid procedure. I am sure that parents and health care providers alike would appreciate a research study on whether the use of emla cream prior to an injection alleviates pain; with the measurable outcome of the infant not exhibiting any of the pain symptoms that are contexts in the pain scale used, confounders would be that the baby was easily consoled with comfort measures (i.e. feeding, holding) after the procedure. 

No one should be giving narcotics without a good indication for these drugs. IMI injections should be avoided. All that is required is a careful assessment of all newborns taking into account the possibility of the baby suffering pain which could be treated. Haphazard assessments are not acceptable

I'm sure that - see Ferri's answer - pain scales are useful for research but I doubt that they are useful for every shot or every heelprick (scales help us to score pain when it's already over). And I agree with Adhikari: every degree of pain due to a medical procedure is a failure.

My first question that I should have asked earlier is who fills out the pain scale? Sharing the instrument in question might shed light on its use for assessing neonatal pain in an acute medical procedure. As a novice researcher I have found a lot of instruments that fail to measure what they are supposed to measure. Development of the Bellieni Neonatal Acute Pain Scale (B-NAPS) might be needed to measure neonatal pain for acute procedures.  

I'm sure that chronic-pain scales are useful to score pain in order to modulate analgesics. While acute-pain scales have scarce utility. Thus, I suggest not to score acute pain but just to detect it (pain we provoke - at any score level - is always a failure). Detecting pain is easy: you just have to know if you are activating parts of the body with nociceptors and then to assess if a sudden reaction (crying or increase in heart rate) appears.