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Biologic markers of pain in the vulnerable infant
1Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Insights
Quantifying pain in young children is challenging. Research explores hormonal stress responses to injury, aiming to improve pain assessment and outcomes in vulnerable infants.
Area of Science:
- Pediatric Pain Management
- Neuroendocrinology
- Infant Health
Background:
- Assessing pain in non-verbal infants and children is difficult.
- Early theories suggested "wound hormones" activated the pituitary-adrenal axis in response to injury.
- Hormonal and metabolic changes (stress response) occur after trauma, but their direct link to pain intensity remains debated.
Purpose of the Study:
- To explore the relationship between stress response and pain in infants and young children.
- To investigate the role of hormonal markers in pain assessment.
- To understand the impact of surgical stress on newborns and potential interventions.
Main Methods:
- Review of existing literature on hormonal and metabolic changes following injury and stress.
- Analysis of studies on the effects of anesthetic agents on stress response.
- Examination of correlations between preoperative stress and postoperative outcomes in newborns.
Main Results:
- Hormonal changes, including corticosteroids and catecholamines, are observed in response to stress.
- Anesthetic agents can significantly reduce intraoperative and postoperative stress responses.
- A strong correlation exists between preoperative stress and postoperative complications in newborns.
Conclusions:
- Understanding the infant's pain response is crucial for preventing adverse outcomes.
- Further research into known and novel biologic markers is needed to improve pain assessment in vulnerable populations.
- Biomarkers hold promise for enhancing the understanding and management of infant pain.
Abstract:
Detecting and quantifying pain in infants and young children is a complex task because young children cannot communicate this subjective phenomenon. In the 1950s, it was postulated that there might be "wound hormones" produced in injured tissues that activated the pituitary-adrenal axis. Research in adults demonstrated that plasma levels of different hormones, including corticosteroids, cathecholamines, growth hormone, and insulin, changed in response to emotionally and physically stressful stimuli. Stress response is the term given to those hormonal and metabolic changes that follow injury or trauma, but the debate as to whether increased stress response is a sign of pain or whether decreased stress response is a sign of diminished pain has not been resolved yet. Following the study of systemic response to surgery, the ability of anesthetic agents to substantially attenuate intraoperative and postoperative stress response has been reported. In newborns, a strong correlation between preoperative stress and postoperative complication rate was found. The full extent of the vulnerable infant's pain is still poorly understood, but further research of known biologic markers and newly discovered ones could promote our understanding of the pain response and increase our ability to prevent undesirable outcome.