title: COMFORT behaviour scale and skin conductance activity: what are they really measuring?
abstract: OBJECTIVE
  To assess how efficiently the COMFORT behaviour scale measures acute pain in neonates, in comparison with skin conductance activity, a validated measure of pain and stress.
  
  
  METHODS
  Images of 36 newborns were analysed before, during and after painful heel pricks to measure glucose levels and compared with skin conductance activity variables.
  
  
  RESULTS
  Scale indicators and skin conductance variables were sensitive to changes in the periods 'during-before' and 'during-after' (Wilcoxon's test, p < 0.01). Significant values were found between all scale indicators and number of waves for Kendall's coefficient (p < 0.05), although responses differed when it came to how long they took to increase and correlations varied from fair to moderate (r < 0.6). Facial tension was more closely related to 15 sec after the painful event, while crying and calmness were more closely related to the later intervals (30 and 180 sec).
  
  
  CONCLUSIONS
  All scale indicators were related to skin conductance activity in all periods, indicating pain perception. Facial tension was the most efficient indicator, while others varied in performance after painful events and possibly indicated stress after trauma. These results are discussed from a phenomenological approach and in an anxiety paradigm.
authors.affiliation: Faculty of Medicine, Campus Darcy Ribeiro, University of Brasilia, DF, Brazil. rmtt@unb.br
authors.forename: Rosana Maria
authors.initials: RM
authors.lastname: Tristão
authors.forename: Naiara Viudes Martins
authors.initials: NV
authors.lastname: Garcia
authors.forename: José Alfredo Lacerda
authors.initials: JA
authors.lastname: de Jesus
authors.forename: Carlos
authors.initials: C
authors.lastname: Tomaz
mesh_terms: D059787:Acute Pain / Q000175:diagnosis*; D001786:Blood Glucose / Q000032:analysis; D001800:Blood Specimen Collection / Q000379:methods; D015331:Cohort Studies; D005149:Facial Expression; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology*; D005865:Gestational Age; D006801:Humans; D018730:Infant Behavior / Q000502:physiology*; D007231:Infant, Newborn; D008297:Male; D009339:Needles; D010147:Pain Measurement / Q000379:methods*; D058748:Pain Perception / Q000502:physiology*; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D001786:Blood Glucose
keywords: COMFORT behaviour scale; Neonate; Pain; Phenomenological approach; Skin conductance