Interactions between sucrose, pain and isolation distress

Blass, Elliott M.; Fitzgerald, Eileen; Kehoe, Priscilla

doi:10.1016/0091-3057(87)90153-5

Cited by 279 publications

(180 citation statements)

References 33 publications

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“…Although the mechanisms mediating the effect of glucose could not be studied, many studies by different authors have shown a primary role of endogenous opioids in pain relief [2,5,16]. This study and previous studies on animals [16,17] suggest a pre-absorptive mechanism. In all probability it is based on sweet taste perception, a human sense well developed even among premature infants at birth [18].…”

Section: Discussionsupporting

confidence: 55%

Analgesic Effect of Oral Glucose in Neonates

Jatana¹,

Dalal²,

Wilson

2003

Medical Journal Armed Forces India

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The International Association for the Study of Pain, has defined pain as "an unpleasant sensory and emotional experience connected with actual or potential tissue damage or described in terms of such damage". It was thought that the newborn baby does not experience pain because of incompletely developed nervous system. However, it has been shown that neurological system known to be associated with pain transmission and modulation, is intact and functional. A study was conducted in our center to study the analgesic effect of administration of oral glucose in various concentrations, in neonates undergoing heel punctures, for collection of blood for investigations. This was compared with the analgesic effects of breast milk (which contains lactose). 125 full term normal neonates with no history of birth asphyxia or underlying neurological abnormality, requiring heel punctures for collection of blood for various investigations were selected for the study. They were matched for gestational age, birth weight and sex distribution and divided into 5 groups of 25 each. One group comprised control subjects and was administered sterile water. 3 groups were administered 1 ml of varying strengths of glucose solutions i.e. 10%, 25% and 50% respectively. The last group was given 1 ml of expressed breast milk (EBM). Prior to heel pricks, state of arousal, baseline heart rate (HR) and transcutaneous oxygen saturation (SpO 2 ) were recorded by pulse oximeter in each neonate. Autolet, a mechanical device for capillary sampling, was used for heel pricks to give equal strength of painful stimulus in each procedure. Audio tape recorder was used to record the cry. The oral solution was administered slowly over 30 seconds by means of a syringe placed in the mouth. Heel puncture was done after 2 minutes, taking all aseptic precautions. HR and SpO 2 were monitored using pulse oximeter. Pain response was assessed, by recording duration of crying, change in HR, change in SpO 2 and facial action score after the procedure. Mean duration of cry and total cry over 5 minutes was significantly less in groups given 25% and 50% glucose solutions as compared to the control group and babies given EBM. Difference in mean increase in HR, fall in SpO 2 were statistically significant between control group, EBM group and neonates given 25% and 50% glucose solutions respectively. Compared to control group, all other administered solutions (10%, 25%, 50% glucose and EBM) were found to reduce physiological and behavioral responses in neonates undergoing heel punctures. 25% and 50% glucose solutions were found to have maximal analgesic effect and both were found to be equally effective. EBM and 10% glucose solution have an equal analgesic effect but less than 25% or 50% glucose. This simple, cheap and safe method of oral analgesia can be easily used in neonates undergoing heel prick procedures during routine neonatal care. MJAFI 2003; 59 : 100-104

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Section: Discussionsupporting

confidence: 55%

Analgesic Effect of Oral Glucose in Neonates

Jatana¹,

Dalal²,

Wilson

2003

Medical Journal Armed Forces India

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“…This may have been done directly through sensory stimulation or indirectly by motor recruitment. Another indirect path may be through activation of opioid mechanisms known to affect ingestive behavior of sweets and fats preferentially in rats and humans (Blass, 1987;Blass, Fitzgerald, & Kehoe, 1987;Marks-Kaufman, 1982;MarksKaufman & Kanarek, 1980;Morley & Levine, 1980).…”

Section: Resultsmentioning

confidence: 99%

Sensorimotor and motivational determinants of hand-mouth coordination in 1-3-day-old human infants.

Blass

Fillion²,

Rochat³

et al. 1989

Developmental Psychology

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Hand-mouth coordination was studied in l-3-day-old human infants by delivering 0.2 ml of sterile 12% sucrose solution intraorally once every 2 min. Sucrose was extraordinarily calming and caused sustained hand-in-mouth contact. The calm state persisted well beyond sucrose termination. Handin-mouth behavior, however, stopped upon sucrose termination, demonstrating stimulus control over this integrated behavior. In subsequent studies we demonstrated that hand-in-mouth behavior was not attributable to calming per se. Moreover, hand activity could be prevented by placing a pacifier in the mouth. This demonstrates that the behavior was under intraoral somesthetic control and was not necessarily the expression of a motor pattern triggered by the sweet taste. These findings are interpreted within the contexts of sucrose (a) calming through an endogenous opioid system and (b) activating suckling-feeding mechanisms, causing the expression of integrated hand, mouth, and head motor patterns.In human development, hand-mouth contact is among the earliest cases of a sustained behavioral pattern that integrates two separate motor systems. Studies of human fetal activity have placed this phenomenon as early as 18 weeks menstrual age (Humphrey, 1968). The behavior remains prominent, appearing within the first hours after birth (Kravitz, Goldenberg, & Neyhus, 1978). According to Korner and her associates (Korner & Beason, 1972; Korner, Church, & Dontchos, 1968;Korner & Kraemer, 1972), it occurs up to 20% of the time in awake infants lying prone or on their sides.Hand-mouth integration changes developmentally, coming under the control of perceptual systems by 5 months of age when infants start to reach for (Hofsten, 1979(Hofsten, , 1982, then to grasp (Yonas & Granrud, 1985), and finally to bring objects to the mouth (Piaget, 1952;Rochat, 1985;Ruff, 1984; see Gibson & Spelke, 1983, for review). The transitional phases between the early behavior that is independent of eye-hand coordination and the later aspects that integrate reaching and grasping have not been identified or analyzed in any systematic fashion.The early expression of hand-mouth contact, its increased frequency during the pregrasping and prereaching months, its expansion during the period when all grasped objects are brought into the mouth, and its eventual contraction to actions supporting ingestive behavior reflect changing elements of control among integrated perceptual, motor, and affective systems. 963brought to-the mouth, could reveal some of the characteristics of perceptual and affective systems determining gustatory and haptic identification of objects, motivational systems concerning ingestive behaviors, and those concerned with affect. The eventual smoothing of hand-to-mouth actions and the ultimate ability to substitute one motor pattern for another (reflecting the initial position of the limb, its relationship with the body, and the characteristics of the grasped object) in the service of bringing an object to the mouth is of interest to students of mo...

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“…Opioid antagonism enhances sensitivity of opioid receptors (Zukin et al, 1982;Lesscher et al, 2003) and diminishes tolerance and physical dependence on opioids . In rodent studies, opioid antagonists block hedonic responses to sweet foods and sugar-induced analgesia (Blass et al, 1987;Blass and Fitzgerald, 1988) without affecting total energy intake (Berridge, 1996;Rodefer et al, 1999).…”

Section: Opioid Antagonists May Improve Hedonic Deficits In Patients mentioning

confidence: 99%

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Elman

Borsook

Lukas

2006

Neuropsychopharmacol

138

142

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Obesity is highly prevalent among patients with schizophrenia and is associated with detrimental health consequences. Although excessive consumption of fast food and pharmacotherapy with such second-generation antipsychotic agents (SGAs) as clozapine and olanzapine has been implicated in the schizophrenia/obesity comorbidity, the pathophysiology of this link remains unclear. Here, we propose a mechanism based on brain reward function, a relevant etiologic factor in both schizophrenia and overeating. A comprehensive literature search on neurobiology of schizophrenia and of eating behavior was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) energy homeostasis, (2) food reward and hedonics, (3) reward function in schizophrenia, and (4) metabolic effects of the SGAs. A mesolimbic hyperdopaminergic state may render motivational/incentive reward system insensitive to low salience/palatability food. This, together with poor cognitive control from hypofunctional prefrontal cortex and enhanced hedonic impact of food, owing to exaggerated opioidergic drive (clinically manifested as pain insensitivity), may underlie unhealthy eating habits in patients with schizophrenia. Treatment with SGAs purportedly improves dopamine-mediated reward aspects, but at the cost of increased appetite and worsened or at least not improved opiodergic capacity. These effects can further deteriorate eating patterns. Pathophysiological and therapeutic implications of these insights need further validation via prospective clinical trials and neuroimaging studies. INTRODUCTIONObesity has reached pandemic proportions and it is rapidly surpassing smoking as a number one killer in the industrialized world (Sturm, 2002;Skidmore and Yarnell, 2004). Its annual cost to the American society is staggering, and is estimated to be around $117 billion owing to related illnesses and loss of productivity (National Institute of Diabetes and Digestive and Kidney Diseases, 2005).In schizophrenia, obesity is twice as prevalent as in the general public, afflicting over half this patient population (Allison et al, 1999a;Dixon et al, 2000; American Diabetes Association, 2004;Marder et al, 2004;Wirshing, 2004). Besides negative psychosocial impacts (distorted selfesteem and societal stigmatization) and medications noncompliance, schizophrenics appear to be particularly susceptible to the detrimental medical sequelae of obesity such as the 'Metabolic Syndrome', which is a cluster of cardiovascular risk factors, including abdominal adiposity, insulin resistance, impaired, glucose tolerance, dyslipidemia, and hypertension (McKee et al, 1986;Mukherjee et al, 1996;Brown et al, 2000;Haupt and Newcomer, 2002;Ryan and Thakore, 2002;Ryan et al, 2003;Holt et al, 2004;Kohen, 2004;Marder et al, 2004;Lieberman et al, 2005).Excessive body weight gain (BWG) could be attributed to a constellation of endocrine, molecular, genetic, demographic, and lifestyle-related factors. Provided that a common tra...

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Interactions between sucrose, pain and isolation distress

Cited by 279 publications

References 33 publications

Analgesic Effect of Oral Glucose in Neonates

Analgesic Effect of Oral Glucose in Neonates

Sensorimotor and motivational determinants of hand-mouth coordination in 1-3-day-old human infants.

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

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