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Effects of perinatal pain and stress
1Pain Neurobiology Laboratory, University of Arkansas for Medical Sciences, Little Rock, USA. anandsunny@exchange.uams.edu
Insights
Preterm neonates in intensive care experience significant pain and stress, potentially altering brain development. Reconsidering pain management is crucial due to the risks of both undertreatment and prolonged analgesic use.
Area of Science:
- Neonatal Medicine
- Neuroscience
- Pain Research
Background:
- Neonatal intensive care involves frequent invasive procedures causing pain and stress in preterm infants.
- Immature pain systems in neonates are vulnerable to long-term consequences from inadequately treated pain.
- Neonatal brain development is sensitive to pain and analgesic exposure, with potential for permanent alterations.
Purpose of the Study:
- To examine the impact of pain and stress on preterm neonates during intensive care.
- To reconsider the risk-benefit analysis of analgesic and sedative use in this population.
- To challenge the traditional view of pain and stress as inevitable in premature birth.
Main Methods:
- Review of existing evidence on neonatal pain and stress.
- Analysis of the immature pain system characteristics in preterm neonates.
- Evaluation of the consequences of both inadequately treated pain and prolonged analgesic therapy.
Main Results:
- Preterm neonates exhibit unique pain system vulnerabilities predisposing them to severe sequelae.
- Repetitive pain or prolonged analgesic use may permanently alter neonatal brain organization.
- The long-term consequences of analgesic therapy in neonates remain largely unknown.
Conclusions:
- Inadequately treated pain in preterm neonates has significant short- and long-term consequences.
- The risk-benefit ratio of analgesic and sedative therapy requires careful reconsideration.
- Advances challenge the inevitability of prolonged pain and stress for premature infants.
Abstract:
Neonatal intensive care exposes preterm neonates to a series of repeated, randomly occurring invasive procedures and handling, resulting in acute pain, chronic pain, and prolonged stress during a critical window associated with epochal brain development. Characteristics of the immature pain system in preterm neonates (such as a low pain threshold, prolonged periods of windup, overlapping receptive fields, immature descending inhibition) predisposes them to greater clinical and behavioral sequelae from inadequately treated pain than older age groups. Evidence for developmental plasticity in the neonatal brain suggests that repetitive painful experiences during this period or prolonged exposure to analgesic drugs may alter neuronal and synaptic organization permanently. Traditionally, clinicians have chosen the perspective that routine use of analgesic or sedative drugs in preterm neonates may create more problems than minimal therapy. However, the immediate and long-term consequences of inadequately treated pain have forced them to reconsider the risk-benefit ratios for such therapy. Whereas the short-term consequences of prolonged analgesic therapy in human neonates are well-known (tolerance, withdrawal, ventilator dependency), long-term consequences are relatively unknown. Advances in the study of repetitive pain associated with routine NICU care have challenged the perspective that prolonged pain and stress were inevitable consequences of premature birth.
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