Consciousness, behavior, and clinical impact of the definition of pain

Anand, K. J. S.; Rovnaghi, Cynthia R.; Walden, Marlene; Churchill, John

doi:10.1016/s1082-3174(99)70029-2

Cited by 36 publications

(27 citation statements)

References 73 publications

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“…30 At birth, the newborn primarily exists in an interoceptive perceptual state with minimal attention to exteroceptive stimuli. 31 Thus, robust responses ensue from internal states such as hunger, thirst, or pain, 32 whereas external auditory, visual, or other stimuli appear to receive limited attention or brain processing.…”

Section: Discussionmentioning

confidence: 99%

Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life

Anand

Runeson

Jacobson

2004

The Journal of Pediatrics

116

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Section: Discussionmentioning

confidence: 99%

Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life

Anand

Runeson

Jacobson

2004

The Journal of Pediatrics

116

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“…Circumcision seemed to disrupt their postnatal adaptation [39] and treatment of circumcision pain with a topical anesthetic decreased their responses to vaccination pain at 4-6 months of age [18]. From other experimental studies, it is now evident that very young infants can readily learn tasks and retain their responses over a period of several days [40]. Together, these studies provide evidence for classical associative learning in both newborn animals and humans, and promote the possibility that memories for pain may be recorded biologically [41], but are not accessible to conscious recall [40].…”

Section: Long-term Behavioral Sequelae Related To Perinatal Complicatmentioning

confidence: 99%

Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior?

Anand

Scalzo²

2000

Neonatology

Self Cite

538

316

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Self-destructive behavior in current society promotes a search for psychobiological factors underlying this epidemic. Perinatal brain plasticity increases the vulnerability to early adverse experiences, thus leading to abnormal development and behavior. Although several epidemiological investigations have correlated perinatal and neonatal complications with abnormal adult behavior, our understanding of the underlying mechanisms remains rudimentary. Models of early experience, such as repetitive pain, sepsis, or maternal separation in rodents and other species have noted multiple alterations in the adult brain, correlated with specific behavioral phenotypes depending on the timing and nature of the insult. The mechanisms mediating such changes in the neonatal brain have remained largely unexplored. We propose that lack of N-methyl-D-aspartate (NMDA) receptor activity from maternal separation and sensory isolation leads to increased apoptosis in multiple areas of the immature brain. On the other hand, exposure to repetitive pain may cause excessive NMDA/excitatory amino acid activation resulting in excitotoxic damage to developing neurons. These changes promote two distinct behavioral phenotypes characterized by increased anxiety, altered pain sensitivity, stress disorders, hyperactivity/attention deficit disorder, leading to impaired social skills and patterns of self-destructive behavior. The clinical important of these mechanisms lies in the prevention of early insults, effective treatment of neonatal pain and stress, and perhaps the discovery of novel therapeutic approaches that limit neuronal excitotoxicity or apoptosis.

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“…Ventilated infants may show signs of agitation, but it is unclear whether this results from anxiety (as in adults) or other causes. 11,15,[19][20][21][22][23]31 Intravenous NSAIDs may be considered as a reasonable alternative to opioid therapy, because they may provide effective analgesia in newborns, spare the use of opioids, and obviate the potential for tolerance. NSAIDs have been used extensively for patent ductus arteriosus closure 131 and intraventricular hemorrhage prevention in preterm neonates, and they have defined pharmacokinetic/pharmacodynamic profiles.…”

Section: Procedural Painmentioning

confidence: 99%

“…20,21 In addition to humanitarian concerns, current consensus is that the treatment and/or prevention of pain is considered beneficial and necessary for preterm and term neonates. [22][23][24][25] Multiple sources of clinical and experimental evidence support the need for providing adequate analgesia/anesthesia for newborns who undergo invasive procedures (medical, surgical, diagnostic, and therapeutic) or develop conditions associated with a significant component of pain (eg, skin burns, necrotizing enterocolitis). 11,26 Minimal anesthesia during surgery has been associated with an increased incidence of intraoperative and postoperative complications leading to poor surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Summary Proceedings From the Neonatal Pain-Control Group

et al. 2006

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Recent advances in neurobiology and clinical medicine have established that the fetus and newborn may experience acute, established, and chronic pain. They respond to such noxious stimuli by a series of complex biochemical, physiologic, and behavioral alterations. Studies have concluded that controlling pain experience is beneficial with respect to short-term and perhaps long-term outcomes. Yet, pain-control measures are adopted infrequently because of unresolved scientific issues and lack of appreciation for the need for control of pain and its long-term sequelae during the critical phases of neurologic maturation in the preterm and term newborn. The neonatal pain-control group, as part of the Newborn Drug Development Initiative (NDDI) Workshop I, addressed these concerns. The specific issues addressed were (1) management of pain associated with invasive procedures, (2) provision of sedation and analgesia during mechanical ventilation, and (3) mitigation of pain and stress responses during and after surgery in the newborn infant. The cross-cutting themes addressed within each category included (1) clinical-trial designs, (2) drug prioritization, (3) ethical constraints, (4) gaps in our knowledge, and (5) future research needs. This article provides a summary of the discussions and deliberations. Full-length articles on procedural pain, sedation and analgesia for ventilated infants, perioperative pain, and study designs for neonatal pain research were published in Clinical Therapeutics (June 2005).www.pediatrics.org/cgi

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Consciousness, behavior, and clinical impact of the definition of pain

Cited by 36 publications

References 73 publications

Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life

Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life

Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior?

Summary Proceedings From the Neonatal Pain-Control Group

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