Zielinski on fetal pain

1. FETAL PAIN

3. 8 weeks

4. Unborn and Newborn Pain
Circa 1978
General belief – Unborn and Newborn did
not “Feel” pain
No analgesia for newborn circumcision
No anesthesia for newborn or neonatal surgery
Main method of surgical anesthesia:
Adhesive Tape

5. Fetal Pain
And Abortion:
The Medical
Evidence
By:
Vincent J. Collins, MD
Steven R. Zielinski, MD
Thomas J. Marzen, Esq.
AMERICANS
UNITED FOR LIFE
Legal Defense Fund
Law and Medicine Series
1984

6. Pain:
an unpleasant sensory
and emotional experience associated
with actual or potential tissue damage
or described
in terms of such damage.

7. Animal Pain – Perception and Alleviation
Kitchell, R.L., Erickson, H.H., eds.
Bethesda, MD.:
American Physiological Soc., 1983

8. Essential Elements
Structure
Function
Aversive Response to
A Noxious Stimulus

10. Look like small
bushes
or the frayed
end of a rope
Respond to
pressure,
heat,
or cold

11. Nerves gather into TRACTS
That enter Dorsal Horn
of the Spinal Cord and go up

12. THALAMUS
Central processing
center for sensory
information

13. ELECTRICAL ACTIVITY
Present at 40 days
A recognizable EEG at 19-20 weeks
NEUROTRANSMITTERS
Substance P, Glutamate, CGRP, VIP
HORMONES
Cortisol, Norepinephrine

14. AVERSIVE RESPONSE
TO A NOXIOUS STIMULUS
Full body aversive responses
to painful stimuli can be easily
witnessed on ultrasound at
13-1/2 weeks gestation…
–Collins, Marzen & Zielinski, 1984

15. NOT JUST PRESENCE, BUT CHANGE
From 16 weeks gestation, the typical change in brain circulation
is seen in the fetal brain in response to a painful stimulus.
Wladimiroff JW et. al. Obstet Gynecol 1987;69:705-9
Cardiovascular responses such as increases in blood
pressure and heart rate, abnormal heart rhythms, or
poor cardiac output.
Hormonal stress responses to painful stimuli as
early as 16 weeks gestational age, possibly sooner.
Anesthesia blunts these responses

16. EXCUSES
Can't speak, can't feel pain.
Reflex
No myelin - no pain.
No Cortex
Minimal or incomplete response
No memory

17. Decorticate and Decerebrate Rigidity

18. Stressed-out, or in (utero)?
http://www.med.upenn.edu/ins/Journal%20Club/08-
09/Fall%202008/Tallie%20Z.%20Baram/tins02.pdf
Abstract
…recent evidence that stressful stimuli have a significant impact on neonatal (rat)
and prenatal (human) hippocampal function and integrity…
Early-life stress could constitute a ‘double-edged sword’: mild stress might
promote hippocampal-dependent cognitive function, whereas severe stress might
impair neuronal function and survival, both immediately and in the long-term.
Importantly, these CRH-mediated processes could be targets of preventive and
interventional strategies.

20. RELIGION
DARWIN
FETAL
PAIN

21. CONSCIOUSNESS
A simple definition of consciousness is sensory
awareness of the body, the self, and the world.
At 20 weeks, the fetal brain has the full complement
of neurons present in adulthood.
Lagercrantz H et. al. Lakartidningen 1991;88:1880-85
By 19-20 weeks, the earliest electroencephalogram
(EEG) recordings are possible.
Flower MJ. J Med Philos 1985;10:237-251
From 20 weeks and beyond, the fetus is fully capable of experiencing pain.
Expert testimony from Dr. Robert White,
pediatric neurosurgeon, before U.S. Congress, June 15, 1995

22. REMEMBRANCE

23. Dr. Vincent Collins

24. Thomas J. Marzen, Esq.

25. http://www.anaesthetist.com/icu/pain/Findex.htm#pain3.htm
Probably the most significant discovery ever in the field of
pain has been the gene c-fos.
The cellular analogue of a viral oncogene, this rather
special gene and its cellular product, the protein called Fos
seem crucial to the profound central nervous
system changes that occur when an animal (or
man) feels pain.
Central nervous system c-fos expression
correlates extremely well with painful
stimulation. Generically, Fos is one of the inducible
transcription factors (ITFs) that controls mammalian gene
expression.

26. We now have a molecular marker for pain!
Even more important, we know that
because c-fos is a proto-oncogene - that
is, it can promote vast intracellular changes
including cellular restructuring and
proliferation
- it is almost certainly involved in the long-
term neurological consequences of
noxious stimulation.

27. FOS has been found in
the fetal bones at least
as early as the 16th
week of gestation.