Can Event-Related Potentials Evoked by Heel Lance Assess Pain Processing in Neonates? A Systematic Review

Abstract

To clarify the possibility of event-related potential (ERP) evoked by heel lance in neonates as an index of pain assessment, knowledge acquired by and problems of the methods used in studies on ERP evoked by heel lance in neonates were systematically reviewed, including knowledge about Aδ and C fibers responding to noxious stimuli and Aβ fibers responding to non-noxious stimuli. Of the 863 reports searched, 19 were selected for the final analysis. The following points were identified as problems for ERP evoked by heel lance in neonates to serve as a pain assessment index: (1) It is possible that the ERP evoked by heel lance reflected the activation of Aβ fibers responding to non-noxious stimuli and not the activation of Aδ or C fibers responding to noxious stimulation; (2) Sample size calculation was presented in few studies, and the number of stimulation trials to obtain an averaged ERP was small. Accordingly, to establish ERP evoked by heel lance as a pain assessment in neonates, it is necessary to perform a study to clarify ERP evoked by Aδ- and C-fiber stimulations accompanied by heel lance in neonates.

Vibration-based mitigation of noxious-evoked responses to skin puncture in neonates and infants: a randomised controlled trial

“…The application of ERPs evoked by heel lance as an assessment tool for neonatal pain has been the topic of a recent systematic review 26. While it has been suggested that ERP evoked by heel lance may be a reflection of the activation of Aβ fibres responding to non-noxious stimuli and not the activation of Aδ or C fibres responding to noxious stimulation, we found a distinct difference in the ERP-based response to vibration compared with skin puncture in our study.…”

Event-related potentials evoked by skin puncture reflect activation of Aβ fibers: comparison with intraepidermal and transcutaneous electrical stimulations

“…However, this index leaves doubts about the research results. In neonates, the ERP evoked by skin puncture in the heel (heel lance) consists of N2P2 and N3P3 waves, and the N3P3 is considered an ERP specific to heel lance (Shiroshita et al, 2021). The N3P3 latency has been reported as 420 ms (Slater et al, 2010b), 383 ms (Verriotis et al, 2016), and 403 ms (Fabrizi et al, 2016) for N3, and as 560 ms (Slater et al, 2010b), 554 ms (Verriotis et al, 2016), and 538 ms (Fabrizi et al, 2016) for P3.…”

“…IES, as an alternative to laser stimulation, avoids limitations such as skin overheating and lesions due to repeated laser stimulation; moreover, it can selectively activate nociceptive Aδ and C fibers in the epidermal layer of the skin when low stimulation current intensities are applied (Inui et al, 2002;Mouraux, Iannetti & Plaghki, 2010). However, the exact latency evoked by the activation of Aδ and C fibers in neonates remains unknown, and whether the ERP evoked by heel lance in neonates reflects activation of Aδ or C fiber is yet to be determined (Shiroshita et al, 2021).…”