The consequences of pain in early life: injury‐induced plasticity in developing pain pathways

Schwaller, Fred; Fitzgerald, Maria

doi:10.1111/ejn.12414

Cited by 230 publications

(194 citation statements)

References 112 publications

(174 reference statements)

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“…acute or repeated injury, inflammatory agents, surgical incision; see reviews [38,39]), findings support clinical data showing long-term changes in response to pain and stress, affective behavior and cognition. For example, adult rats exposed to surgery or inflammatory pain in the first postnatal week (developmentally comparable to a 24-36 GW infant [40]) exhibit significant hypo-sensitivity to acute thermal or mechanical noxious stimuli, but hyper-sensitivity to chronic, more intense nociceptive stimulation [41,42].…”

Section: The Long-term Impact Of Early Life Pain In Humanssupporting

confidence: 72%

Exposure to early life pain: long term consequences and contributing mechanisms

Victoria

Murphy

2016

Current Opinion in Behavioral Sciences

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From an evolutionary perspective, adaptations of an organism to its early environment are essential for survival. The occurrence of early life perturbation, coincident with increased developmental plasticity, provides a unique opportunity for such adaptations to become programmed and persist throughout life. However, adaptations that are beneficial to maintaining homeostasis in one's early environment may result in extreme response strategies that confer vulnerability or dysfunction later in life. This review summarizes recent findings in human and animal studies demonstrating that early life pain results in a hypo-/hyper-sensitive phenotype in response to acute and persistent pain and stress later in life. Changes in cognition and immune function in response to early life pain have also been observed. Recent data on the neural mechanisms underlying these long-term changes are discussed, as well as potential strategies to minimize the impact of early life pain.

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Section: The Long-term Impact Of Early Life Pain In Humanssupporting

confidence: 72%

Exposure to early life pain: long term consequences and contributing mechanisms

Victoria

Murphy

2016

Current Opinion in Behavioral Sciences

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“…It is believed that the mechanism of birth influences pain perception. Previous research has found that new-borns born by assisted vaginal birth have the highest severity of pain, compared to those born by the normal mechanism or Caesarean section [10,11]. The comparison of the severity of pain in children born by normal birth and Caesarean section in this study supports the results of our study, i.e.…”

Section: Discussionsupporting

confidence: 91%

Factors affecting the severity of procedural pain in new-borns

Petleshkova¹,

Krasteva²,

Dragusheva³

et al. 2018

biomedicalresearch

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In recent years, the objectification and control of neonatal pain has caused many discussions. Given its early and late effects, researchers' efforts are aimed at minimizing the impact of maternal and childrelated factors, with a possible effect on pain sensitivity in new-borns. Our aim is to study the influence of maternal factors (daily intake of one or more cups of coffee and bacterial vaginosis during pregnancy, birth mechanism, blood group and Rhesus factor) and child-related factors (gestational age, gender, blood group and Rhesus factor) on the severity of procedural pain, caused by puncture of the heel. The present study includes 67 infants carried to term and aged 72-84 h, born by varying birth mechanisms and with an optimal Apgar score. By video surveillance before, during and after the procedure, the pain was assessed using the Neonatal Infant Pain Scale (NIPS). The results were measured 30 s and 5 min after the heel puncture. The following statistical methods were used: Kruskal-Wallis test, X 2 assay (Chisquared test), Student's t-test and Mann-Whitney's u-test, with a factor of significance of p<0.05. At the 30-s mark, there was no statistically significant difference in the severity of pain among the new-borns in the groups: pregnant women, which have consumed coffee and had bacterial vaginosis during the pregnancy. The mechanism of birth, gender and Rhesus factor of the new-born and mother did not change the severity of pain. New-borns with a larger gestational age and those from mothers with the blood group AB showed a significantly increased response to procedural pain. At the 5-min mark, none of the studied factors associated with the mother and new-born had a significant effect on the degree of pain. The influence of maternal and child related factors on the severity of procedural pain in new-borns is limited.

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“…Animal models of early life pain support clinical findings demonstrating a long-term impact on subsequent responses to pain and stress (Schwaller and Fitzgerald, 2014). Acute or repeated exposure to early life pain induced by foot shock, surgery, or inflammatory agents results in general thermal or mechanical hypoalgesia (i.e.…”

Section: 2 Early-life Pain Impairs Stress and Pain Respondingmentioning

confidence: 79%

The long-term impact of early life pain on adult responses to anxiety and stress: Historical perspectives and empirical evidence

Victoria

Murphy

2016

Experimental Neurology

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Approximately 1 in 6 infants are born prematurely each year. Typically, these infants spend 25 days in the Neonatal Intensive Care Unit (NICU) where they experience 10–18 painful and inflammatory procedures each day. Remarkably, pre-emptive analgesics and/or anesthesia are administered less than 25% of the time. Unalleviated pain during the perinatal period is associated with permanent decreases in pain sensitivity, blunted cortisol responses and high rates of neuropsychiatric disorders. To date, the mechanism(s) by which these long-term changes in stress and pain behavior occur, and whether such alterations can be prevented by appropriate analgesia at the time of insult, remains unclear. Work in our lab using a rodent model of early life pain suggests that inflammatory pain experienced on the day of birth blunts adult responses to stress- and pain-provoking stimuli, and dysregulates the hypothalamic pituitary adrenal (HPA) axis in part through a permanent upregulation in central endogenous opioid tone. This review focuses on the long-term impact of neonatal inflammatory pain on adult anxiety- and stress-related responses, and underlying neuroanatomical changes in the context of endogenous pain control and the HPA axis. These two systems are in a state of exaggerated developmental plasticity early in postnatal life, and work in concert to respond to noxious or aversive stimuli. We present empirical evidence from animal and clinical studies, and discuss historical perspectives underlying the lack of analgesia/anesthetic use for early life pain in the modern NICU.

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The consequences of pain in early life: injury‐induced plasticity in developing pain pathways

Cited by 230 publications

References 112 publications

Exposure to early life pain: long term consequences and contributing mechanisms

Exposure to early life pain: long term consequences and contributing mechanisms

Factors affecting the severity of procedural pain in new-borns

The long-term impact of early life pain on adult responses to anxiety and stress: Historical perspectives and empirical evidence

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