Recent pain/analgesia articles

Several very recent articles have addressed issues of pain and analgesia in the newborn.

van Ganzewinkel CJ, et al. Chronic pain in the newborn: toward a definition. The Clinical journal of pain. 2014;30(11):970-7. This article describes a consensus building expert-based process, to develop a definition of chronic pain. An interesting process.

Taddio AP, et al. Teaching Parents to Manage Pain During Infant Immunizations: Laying the Foundation for Better Pain Management Practices. Clinical Journal of Pain. 2014;30(11):987-94. Anna Taddio and the group at Sick Kids in Toronto have previously published a parent information tool to help parents understand what they can do to reduce pain associated with vaccination. In this study the 4 groups of parents all receive the pamphlet, but 2 of the groups got the pamphlet after tests evaluating their knowledge. The study showed an improvement in knowledge in the groups that got the pamphlet. They also examined what pain interventions the mothers used around the 2 month vaccination of their infants. The study didn’t have a lot of power for this outcome, and didn’t show any real differences. In fact the major strategies that mothers in all groups used were “acting calm” followed by “”holding”. Other proven strategies such as breast feeding or sugary solutions were little used, which is a real shame as they are cheap, harmless and effective.

Maitra S, et al. Epidural anesthesia and analgesia in the neonate: a review of current evidences. J Anesth. 2014;28(5):768-79. A well done systematic review. Almost no RCTs, so the authors describe and review the other kinds of evidence available. We should probably use regional anaesthesia more frequently, but the potential CNS toxicity of the agents needs more work. Which is also true for “systemic” anaesthetic agents.

As shown in this study: Backeljauw B, et al. Cognition and Brain Structure Following Early Childhood Surgery With Anesthesia. Pediatrics. 2015. In this study children who had an MRI as part of a study of MRIs among “volunteers” who were generally in good neurologic health. MRIs were done between 5 years and 18 years of age, the word “volunteers” therefore presumably refers to the subjects or to their parents. Among the subjects there were 53 who had previously had at least one surgery before the age of 4, many,  where ENT surgeries, a few general surgeries and no cardiac or neurosurgery in this group.  A battery of neuropsychologic tests were performed. The subjects had lower scores on a wide range of tests compared to matched controls. There were no overall differences in MRI volumetric measures between the groups, but there was a correlation between lower IQ scores and smaller grey matter volumes. Almost all of the anesthetics were with inhaled, volatile agents. A study with many limitations, acknowledged by the authors, but which has results consistent with many other studies showing adverse effects of early surgery with anaesthesia, and adding the MRI data.

Valeri BO, et al. Pain reactivity in preterm neonates: examining the sex differences. European Journal of Pain. 2014;18(10):1431-9. A prospective evaluation of pain responses to a skin puncture in preterm infants found little difference between males and females. Boys heart rate responses were a little more marked, but not enough difference to really make much of.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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