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The neurobiology of pain: developmental aspects
1Department of Anatomy & Developmental Biology, University College London. m.fitzgerald@ucl.ac.uk
Insights
Painful procedures in infants undergoing neonatal intensive care can negatively impact development. Immature nervous systems in newborns process pain differently, potentially causing long-term changes in pain pathways.
Area of Science:
- Neonatal intensive care
- Neuroscience
- Pediatric pain management
Background:
- Infants in neonatal intensive care units (NICUs) often undergo invasive procedures that cause pain.
- Pain perception and processing in the immature neonatal nervous system differ significantly from older children and adults.
- Untreated or poorly managed pain in infancy can have lasting consequences beyond immediate distress.
Purpose of the Study:
- To discuss sensory responses to painful procedures in the immature neonatal nervous system.
- To highlight pain in infancy as a critical developmental issue.
- To explain how early pain exposure can alter long-term pain processing.
Main Methods:
- This article is a discussion and review of existing knowledge on neonatal pain processing.
- It synthesizes information on sensory responses in the immature nervous system.
- It examines the developmental implications of pain in neonates.
Main Results:
- The immature newborn spinal cord has lower excitation thresholds and increased sensitization, amplifying the effects of painful stimuli.
- The high plasticity of neonatal peripheral and central sensory connections means early pain can cause lasting structural and functional changes in pain pathways.
- These alterations can persist from infancy into adulthood.
Conclusions:
- Pain experienced by infants in the neonatal intensive care unit is not just a transient event but a significant developmental issue.
- Early life pain exposure can lead to enduring changes in pain processing, affecting individuals throughout their lives.
- Understanding these mechanisms is crucial for optimizing pain management strategies in neonates to prevent long-term consequences.
Abstract:
Invasive procedures that would be painful in children and adults are frequently performed on infants admitted to the neonatal intensive care unit. This article discusses sensory responses to these procedures in the immature nervous system and highlights the fact that, in addition to causing distress and delayed recovery, pain in infancy is also a developmental issue. First, the immaturity of sensory processing within the newborn spinal cord leads to lower thresholds for excitation and sensitization, therefore potentially maximizing the central effects of these tissue-damaging inputs. Second, the plasticity of both peripheral and central sensory connections in the neonatal period means that early damage in infancy can lead to prolonged structural and functional alterations in pain pathways that can last into adult life.