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4: Documentation

4: Subjection to such painful stimuli is associated with long-term harmful neurodevelopmental effects, such as altered pain sensitivity and, possibly, emotional, behavioral, and learning disabilities later in life.

DOCUMENTATION:

1. Van de Velde, 2006, p.234, col.1, para.3, “It is becoming increasingly clear that experiences of pain will be ‘remembered’ by the developing nervous system, perhaps for the entire life of the individual.22,33 These findings should focus the attention of clinicians on the long-term impact of early painful experiences, and highlight the urgent need for developing therapeutic strategies for the management of neonatal and fetal pain.”

Van de Velde M, Jani J, De Buck F, Deprest J. Fetal pain perception and pain management. Seminars in Fetal & Neonatal Medicine. 11 (2006) 232-236.

22 Vanhalto S, van Nieuwenhuizen O. Fetal Pain? Brain & Development.  22 (2000) 145-150.

33Anand KJS. Pain, plasticity, and premature birth: a prescription for permanent suffering? Nature Medicine.  6 (2000) 971-973.

2. Vanhatalo, 2000, p.148, col.2, para.4, “All these data suggest that a repetitive, or sometimes even strong acute pain experience is associated with long-term changes in a large number of pain-related physiological functions, and pain or its concomitant stress increase the incidence of later complications in neurological and/or psychological development.”

Note: Vanhalto & Niewenhuizen believe that pain requires cortical processing; nevertheless, they acknowledge that, “noxious stimuli may have adverse effects on the developing individual regardless of the quality or the level of processing in the brain…after the development of the spinal cord afferents around the gestational week 10, there may be no age limit at which one can be sure noxae are harmless.” (p.149, col.1, para.2).

Vanhalto S, van Nieuwenhuizen O. Fetal Pain? Brain & Development.  22 (2000) 145-150.

3. Gupta, 2008, p.74, col.2, para.3, “ There may be long-term implications of not providing adequate fetal analgesia such as hyperalgesia, and possibly increased morbidity and mortality.”

Gupta R, Kilby M, Cooper G. Fetal surgery and anaesthetic implications. Continuing Education in Anaesthesia, Critical Care & Pain. 8:2 (2008) 71-75.

4. Lee, 2005, p.951, col.1, para.3, “When long-term fetal well-being is a central consideration, evidence of fetal pain is unnecessary to justify fetal anaesthesia and analgesia because they serve other purposes unrelated to pain reduction, including … (3) preventing hormonal stress responses associated with poor surgical outcomes in neonates71,72; and (4) preventing possible adverse effects on long-term neurodevelopment and behavioral responses to pain.73-75

Note: Lee et al. believe that pain requires conscious cortical processing, which they deem unlikely until 29 or 30 weeks; nonetheless, they acknowledges this finding.

Lee SJ, Ralston HJP, Drey EA, Partridge, JC, Rosen, MA. A Systematic Multidisciplinary Review of the Evidence. Journal of the American Medical Association. 294:8 (2005) 947-954.

71Anand KJ, Hickey PR.Halothane-morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery. New England Journal of Medicine. 326 (1992) 1-9.

72Anand KJ, Sippell WG, Aynsley-Green A. Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. Lancet. 329 (1987) 62-66.

73Johnston CC, Stevens BJ. Experience in a neonatal intensive care unit affects pain response. Pediatrics. 98 (1996) 925-930.

74Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 349 (1997) 599-603.

75Taylor A, Fisk NM, Glover V. Mode of delivery and subsequent stress response. Lancet. 355 (2000) 120.

5.Rosen, 2009, p131-132, “Although we do not know exactly when the fetus can experience pain, noxious stimulation during fetal life causes a stress response, which could have both short- and long-term adverse effects on the developing central nervous system.”

Mark A. Rosen, “Anesthesia for Fetal Surgery and Other Intrauterine Procedures,” in Chesnut’s Obstetric Anesthesia: Principles and Practice, ed. David H. Chestnut et al (Philadelphia: Mosby, 2009), 131-132.

6. Van de Velde, 2012, “This nociceptive stimulation of the fetus also has the potential for longer-term effects, so there is a need for fetal analgesic treatment.”

Marc Van de Velde & Frederik De Buck, Fetal and Maternal Analgesia/Anesthesia for Fetal Procedures. Fetal Diagn Ther 31(4) (2012) 201-9.

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