fetal pain
Fetal and Neonatal Pain and Long Term ImplicationsOver the last decade, the perception of pain and stress in fetal and neonatal life has attracted great attention. This is partly due to an increasing understanding of fetal physiology and a greater number of invasive techniques used in today's medicine. The greater frequency of abortions, caesarean sections and intra uterine interventions have turned increased attention onto the subject after decades of common belief being that the fetus and neonate felt no pain.The most important evidence is anatomical. This shows that the neuroanatomical connections for nociception are in place by the 24th week of gestation. Many experts however believe that the fetus only experiences "mindless reflex responses" which are a mechanism of protection for an adapting organism that has not yet developed a mature sensory and effector system. There is evidence present to suggest that a single painful experience can alter development and sensitisation of the infant to pain and stress later in life.In the following essay I am going to review the evidence supporting the long term effects of painful and stressful experiences suffered by fetuses and the newborn. I will also asses
It is difficult to assess and measure pain in adults who can communicate and express their feelings. In their investigations they divided the infant monkeys into three different groups. They hypothesised that the Emla cream would obstruct nociceptive input originating from the site of injury during circumcision and therefore not have any long term effects. They injected the left hindpaw of neonatal rats with CFA to bring about inflammatory pain. During this crucial stage in development there is increased plasticity so therefore the effects of pain or stress can have a greater impact. Short-term effects of these behavioural changes could affect the newborn's adaptation to its postnatal environment, e. They also hypothesized that the pain suffered during circumcision may produce permanent changes on the infant's pain behaviour due to alterations in which pain stimuli were processed in the CNS. Clarifying these times of greater sensitivity to pre and postnatal pain and stress will help understand the mechanisms by which these factors affect the developing nervous system. One third of the subjects were given no treatment, one third placebo and the other third Emla cream. Taddio et al 1997 investigated whether pre-treatment of circumcision pain using lidocaine-prilocaine cream (Emla) would attenuate the pain felt by the infant in an intramuscular vaccine 4-6 months later. Bhutta et al then hypothesized that the repetitive injections given to the neonatal rats would decrease their pain threshold at both a spinal and supraspinal level. Cutaneous HypersensitivityFitzgerald et al 1989 carried out a study on newborn infants to assess whether tissue damage caused by heel lancing had any effect on the flexion reflex. The results they obtained showed that the threshold of the flexion reflex dropped to half of the control value when testing was carried out in the area of tissue damage caused by heel lancing. Nylon hairs were pushed towards the foot until there was sufficient force to cause the neonate to withdraw his/her limb. Trained observers then measured infant facial action, duration of crying and other characteristic responses thought to be caused due to pain.
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