Venipuncture activates the cerebral cortex in children with intellectual disability
Stefano Bembich1, Giuliana Morabito2, Valentina Simeon2
1IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy.
Insights
Children with intellectual disability show distinct brain activity and report more pain during venipuncture compared to healthy peers, even with anesthesia. Further research is needed on factors like anxiety and restraint.
Area of Science:
- Neuroscience
- Pediatrics
- Pain Management
Background:
- Understanding pain perception in children with intellectual disability is crucial for effective management.
- Venipuncture is a common, painful procedure that can cause distress.
Purpose of the Study:
- To investigate cortical activation patterns during venipuncture in children with intellectual disability.
- To compare pain and distress levels between children with and without intellectual disability during a painful procedure.
Main Methods:
- A cohort study involving 16 children with intellectual disability and 20 cognitively healthy children (ages 4-17).
- Cerebral near-infrared spectroscopy (NIRS) measured oxyhaemoglobin and deoxyhaemoglobin (Hbb) variations.
- Validated pain scales assessed pain and distress.
Main Results:
- Children with intellectual disability showed bilateral somatosensory and right motor cortex activation (p<0.006).
- Cognitively healthy peers did not exhibit cortical activation.
- Children with intellectual disability reported significantly more pain (p=0.001).
Conclusions:
- Intellectual disability is associated with unique cortical responses to painful stimuli, even with topical anesthesia.
- Children with intellectual disability experience greater pain during venipuncture.
- Further research should explore the impact of anxiety, fear, and physical restraint on pain perception.
Objective:
To evaluate the pattern of cortical activation during a painful procedure, such as a venipuncture, in children with intellectual disability and compare it with that of cognitively healthy children.
Study Design And Setting:
A cohort study was conducted and cortical activation was assessed by multichannel cerebral near-infrared spectroscopy to monitor variations in oxyhaemoglobin and deoxyhaemoglobin (Hbb) in children with and without intellectual disability during a venipuncture for blood sampling with topical anaesthesia. Pain and distress were assessed as well using different validated pain scales (visual analogue scale and Non-Communicating Children's Pain Checklist-Postoperative Version for children with intellectual disability), and compared between groups.
Participants:
16 children with severe to profound intellectual disability and 20 cognitively healthy peers (age range: 4-17 years).
Results:
When Hbb was analysed, children with intellectual disability exhibited a bilateral activation of the somatosensory (p<0.006) and right motor cortex (p=0.0045), whereas cognitively healthy peers never showed a cortical activation. Children with intellectual disability also showed more pain than controls (p=0.001).
Conclusions:
When subjected to a painful procedure, only children with intellectual disability show an activation of the cerebral cortex, even if topical anaesthesia is applied, and express more pain than cognitively healthy peers. The role of other issues in painful procedures, such as anxiety, fear or physical restraint, deserves further investigation.
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