Relying on behavioral indicators, like crying, to assess surgical pain in neonates underestimates actual pain and could lead to long-term effects on brain development and future pain sensitivity, according to research presented at the 2018 American Pain Society Scientific Summit (Curr Biol 2017;27:3846-3851).
“Infants respond to noxious stimulation from birth, but the neural pathways underlying pain behavior and pain perception change through infancy, childhood and adolescence,” said Maria Fitzgerald, PhD, FMedSci FRS, a professor of developmental neurobiology at University College London. “Understanding how pain is processed at each stage has considerable impact on the clinical assessment and treatment of pain in children.”
Dr. Fitzgerald and her fellow researchers studied the stress levels of hospitalized neonates who underwent painful procedures during their stay.
The study participants (n=56, age range 36-42 weeks) were simultaneously measured for brain activity, behavioral responses and hormonal stress responses after undergoing a clinically necessary lancing of the heel. The results showed that neonates who were more stressed had stronger brain responses after painful procedures but that stress was not accompanied by changes in behavior. To conduct the tests, Dr. Fitzgerald used brain imaging techniques, electroencephalography and near infrared spectroscopy after a participant experienced a painful event.
Dr. Fitzgerald said that this research shows that providers who are treating hospitalized neonates should assume they are experiencing pain and use any available therapies to address the pain.
“We realized that as the perception of pain is generated by the central nervous system, our research needed to move toward measuring neuronal activity responsible for the sensation of pain,” said Dr. Fitzgerald.