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Acute and chronic pain in children
1Faculty of Health and Life Sciences, School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK, Gareth.Hathway@nottingham.ac.uk.
Insights
Pain processing in children differs significantly from adults due to developmental factors. Early life pain can alter lifelong pain responses, impacting chronic pain development and severity.
Area of Science:
- Neuroscience
- Developmental Biology
- Pain Research
Background:
- Neonatal and pediatric pain perception varies from adult pain.
- Non-verbal neonates face diagnostic and management challenges for pain.
- Early life pain exhibits lowered thresholds and exaggerated behavioral responses.
Purpose of the Study:
- To discuss chronic pain in childhood.
- To explore structural and functional differences in acute pain processing between children and adults.
- To address how early life pain can modify lifelong pain responses.
Main Methods:
- Review of developmental neurobiology of pain circuits.
- Analysis of spinal cord dorsal horn excitability and inhibition.
- Examination of neurotransmitter and neuromodulator expression in early life.
- Assessment of brainstem inhibitory inputs.
- Investigation of neuronal and non-neuronal cell interactions in pain response.
Main Results:
- Neonatal pain processing involves increased spinal dorsal horn excitability and decreased inhibition.
- Immature neurotransmitter expression and reduced brainstem input contribute to altered pain responses.
- Developmental differences in pain processing affect acute pain reactions.
- Early life pain influences the incidence, severity, and duration of chronic pain.
Conclusions:
- Pediatric pain processing is fundamentally different from adult pain due to developmental immaturity.
- These developmental differences have lasting effects on pain perception and chronic pain development.
- Understanding these differences is crucial for effective pain management in children and long-term outcomes.
Abstract:
Pain in neonates and children differs to that in adults. One of the many challenges associated with the diagnosis and management of pain in early life is that neonates are non-verbal and therefore incapable of communicating their pain effectively to their caregivers. Early life pain is characterised by lowered thermal and mechanical thresholds, and exaggerated and often inappropriate behavioural reactions to pain. These differing behavioural reactions are underpinned by increased excitability/decreased inhibition within the spinal dorsal horn. This itself is the result of immaturity in the anatomical expression of key neurotransmitters and neuromodulators within spinal pain circuits, as well as decreased inhibitory input to these circuits from brainstem centres, and an immature relationship between neuronal and non-neuronal cells which affects pain response. These differences between early and adult pain impact upon not just acute reactions to pain, but also the incidence, severity and duration of chronic pain. In this chapter, chronic pain in childhood is discussed, as are the structural and functional differences that underpin differences in acute pain processing between adults and children. The ability of pain that occurs in early life to alter life-long pain responding is also addressed.
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