Neonatal pain: A journey spanning three decades

Abstract

From 1980 into present day, 2020, the evolution of neonatal pain research is told as a journey by one researcher, Celeste Johnston. At the beginning of her work, there was essentially no interest or work in the area. She was fortunate to be led into the area by a clinical problem: how to determine the amount of pain babies in the NICU were experiencing. That question resulted in over three decades of work with neonates. Measuring pain was the first challenge and is one that remains a focus of current research. Initially, the only choices for treating pain in neonates were either opioids or anesthetics, each with problems. Research on sweet taste and more recently on skin‐to‐skin contact has offered effective and safe options for procedural pain. Although progress has been made in the incidence of pain management in infants, it still is far less than it could be. Steps along the way of measurement, treatment, and knowledge utilization are chronicled by this researcher.

Use of glucose for pain management in premature neonates: a systematic review and meta-analysis protocol

“…Though previously considered a non-existent element, the concept of pain management as an integral part of neonatal care has gained attention. 1 …”

“… 9 11–16 In this sense, it is worth mentioning that neonatal pain has been undertreated in health services. 1 Neonates need adequate treatment for procedural pain management. 1 9 11–16 Therefore, studies with concrete and reliable scientific data are desirable to facilitate changes in institutional protocols for pain management.…”

“…In addition, inadequate management of procedural pain may lead to decreased transcutaneous oxygen saturation, increased heart and respiratory rates, and increased cortisol levels in children, 1 as well as other more severe developmental changes such as postnatal growth retardation, early neurodevelopmental deficits, exacerbated cortical activation and altered brain development. 3 …”

Future roles of artificial intelligence in early pain management of newborns

“…Before 1980, pain in newborns was for the most part discounted, ignored, or under‐treated 4 due to several factors, including the lack of a working definition for pain in newborns; and, self‐reporting as the gold standard for pain assessment, which is clearly not possible for newborns in NICU where only indirect pain assessment is possible. 5 , 6 In contrast to assumptions that the undeveloped neural pathways of newborns do not support the perception or recall of perinatal pain, substantial basic and clinical research confirms that pain triggers a range of chemical, behavioral, and morphological changes in the neonate's developing nervous system. 7 , 8 , 9 Recent studies using functional magnetic resonance imaging (fMRI) confirm that pro‐pain brain regions undergo similar activation patterns in infants as in adults.…”

To know where we came from

“…Céleste Johnston describes how her research program unfolded from a clinical nursing question on how to measure pain in infants and into researching various aspects of assessment and management of pain. In recent years, her research has addressed the involvement of mothers in alleviation of pain, 3 illustrating the growing awareness that to understand and be able to alleviate pain we have to take into consideration the social context.…”