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  • Review Article
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Neonatal Infant Pain Scale in assessing pain and pain relief for newborn male circumcision


Circumcision—partial or total removal of the penile prepuce—requires cutting nerve-laden, sensitive genital tissue and is therefore liable to be painful. The aim of this review is to evaluate the evidence concerning pain felt by newborns during circumcision and to determine whether current analgesic methods can eliminate such pain. I performed a search in medical databases, selecting the trials published in the last 20 years that assessed pain in neonatal circumcision. Twenty-three trials have been retrieved. To get reliable findings, those trials that used validated pain scales were selected; then it was investigated which trials had comparable data for using the same pain scale. The only pain scale that was used in more than two trials was the modified Neonatal Infant Pain Scale (mNIPS) that ranges 0–6. The results of these trials show that none of the analgesic strategies used obtained the absence of pain. Some differences between circumcision techniques can be noticed, but most assessments exceed the score of 3, chosen as the clinically significant pain.

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Fig. 1: The PRISMA selection of trials.
Fig. 2: Pain level during circumcision with different analgesic methods.

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Data availability

Data of this review are available on demand.


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Correspondence to Carlo V. Bellieni.

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Bellieni, C.V. Neonatal Infant Pain Scale in assessing pain and pain relief for newborn male circumcision. Int J Impot Res 35, 282–285 (2023).

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