Summary Proceedings From the Neonatal Pain-Control Group

Abstract

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

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

“…However, neonatal pain assessment is not an easy task and the existence of several scales can be confusing. 53 More research is needed on the implementation of pain scales at the bedside and on the ways of optimising pain management with pain assessments in neonates. Opioids or benzodiazepines were weaned gradually in 39%, 31%, and 42% of neonates in the TV, NIV, and SV groups, respectively.…”

Fewer infants than older patients in paediatric randomised controlled trials

“…Clearly, there is an urgent need for high-quality studies in neonates and infants. Nevertheless, despite a few initiatives to promote research in neonates, [32] most paediatric studies are done in children and adolescents, as shown by a study of 253 trials conducted to obtain paediatric exclusivity extensions. [33] Drugs studied in these trials are mainly used in older children and adolescents for conditions such as hypertension, systemic autoimmune disorders, and gastrointestinal disorders.…”

Tail docking in horses: a review of the issues

“…In a similar way, pain in human newborns was ignored for a long time. Their capacity to feel pain and, more generally, to undergo a stress when submitted to surgical operations or diverse manipulations has been studied only relatively recently (see, for instance, Anand, 1990;Gunnar et al, 1988 and1992;Anand et al, 2006). Post-operative pain and chronic health problems Pain associated with amputation and other surgical interventions is not limited to the time of the operation.…”