fMRI reveals neural activity overlap between adult and infant pain

Abstract

Limited understanding of infant pain has led to its lack of recognition in clinical practice. While the network of brain regions that encode the affective and sensory aspects of adult pain are well described, the brain structures involved in infant nociceptive processing are less well known, meaning little can be inferred about the nature of the infant pain experience. Using fMRI we identified the network of brain regions that are active following acute noxious stimulation in newborn infants, and compared the activity to that observed in adults. Significant infant brain activity was observed in 18 of the 20 active adult brain regions but not in the infant amygdala or orbitofrontal cortex. Brain regions that encode sensory and affective components of pain are active in infants, suggesting that the infant pain experience closely resembles that seen in adults. This highlights the importance of developing effective pain management strategies in this vulnerable population.DOI: http://dx.doi.org/10.7554/eLife.06356.001

A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

“…Heel lances in newborns elicit nociceptive-specific EEG brain activity associated with reflex withdrawal dependent on the stimulus intensity in the absence of clinical pain, which is difficult to measure (118). Brain imaging of newborn infants demonstrates increased sensitivity to nociceptive stimuli with greater amplitude and duration of reflex withdrawal compared to adults (119). Goksan and colleagues (2015) reported the activation of 18 out of 20 brain areas (including anterior cingulate cortex, bilateral thalamus, all divisions of insular cortex, and primary somatosensory cortex) in infants in response to nociceptive stimuli.…”

What do we really know about newborn infant pain?

“…Clinically required, tissue-breaking stimuli are hard to adapt to magnetic imaging, so functional magnetic resonance imaging (fMRI) studies have relied on experimental brushing, von Frey hair punctate and pinprick stimulation of the skin (Williams et al 2015;Goksan et al 2015). In a study of 19 term infants with a mean age of 13 days, distinct patterns of functional brain activation were evoked by brush and von Frey hair punctate stimulation, which were reduced, but still present, under chloral hydrate sedation.…”

“…Recently, the field has turned to exciting new evidence of pain-induced activity in the brain of human infants, which offers real insight into how pain is processed at higher levels of the newborn CNS (Slater et al 2006(Slater et al , 2010cFabrizi et al 2011;Williams et al 2015;Goksan et al 2015). This has provided previously unknown information about how much noxious information reaches the newborn brain and has opened the door to new research into the functional development of early nociceptive circuits in the somatosensory cortex and other brain areas in man.…”

Douleur et opioïdes forts : des recommandations d’experts aux nouvelles réflexions. Du bon usage des opioïdes

“…[16]. Longtemps sous-évaluée, voire ignorée, la perception de la douleur par l'enfant est aujourd'hui mieux considérée [17,18]. De surcroît, plusieurs études ont démontré les conséquences néfastes sur le développement physiologique, psychologique et social ainsi que sur les futures expériences douloureuses d'interventions réalisées chez l'enfant sans analgésie adé-quate, y compris chez l'enfant prématuré [17,19,20].…”