Unborn and Newborn Pain Circa 1978General belief – Unborn and Newborn didnot “Feel” painNo analgesia for newborn circumcisionNo anesthesia for newborn or neonatal surgeryMain method of surgical anesthesia: Adhesive Tape
Fetal Pain And Abortion: The Medical Evidence By: Vincent J. Collins, MD Steven R. Zielinski, MDThomas J. Marzen, Esq. AMERICANS UNITED FOR LIFE Legal Defense FundLaw and Medicine Series 1984
Pain: an unpleasant sensoryand emotional experience associatedwith actual or potential tissue damage or described in terms of such damage.
Essential Elements Structure FunctionAversive Response to A Noxious Stimulus
Look like smallbushes or the frayedend of a ropeRespond topressure,heat,or cold
Nerves gather into TRACTSThat enter Dorsal Hornof the Spinal Cord and go up
THALAMUSCentral processingcenter for sensoryinformation
ELECTRICAL ACTIVITY Present at 40 days A recognizable EEG at 19-20 weeksNEUROTRANSMITTERS Substance P, Glutamate, CGRP, VIPHORMONES Cortisol, Norepinephrine
AVERSIVE RESPONSETO 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
NOT JUST PRESENCE, BUT CHANGEFrom 16 weeks gestation, the typical change in brain circulationis seen in the fetal brain in response to a painful stimulus. Wladimiroff JW et. al. Obstet Gynecol 1987;69:705-9Cardiovascular responses such as increases in bloodpressure and heart rate, abnormal heart rhythms, orpoor cardiac output.Hormonal stress responses to painful stimuli asearly as 16 weeks gestational age, possibly sooner. Anesthesia blunts these responses
EXCUSESCant speak, cant feel pain.ReflexNo myelin - no pain.No CortexMinimal or incomplete responseNo memory
Stressed-out, or in (utero)?http://www.med.upenn.edu/ins/Journal%20Club/08-09/Fall%202008/Tallie%20Z.%20Baram/tins02.pdfAbstract…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 mightpromote hippocampal-dependent cognitive function, whereas severe stress mightimpair neuronal function and survival, both immediately and in the long-term.Importantly, these CRH-mediated processes could be targets of preventive andinterventional strategies.
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 complementof neurons present in adulthood. Lagercrantz H et. al. Lakartidningen 1991;88:1880-85By 19-20 weeks, the earliest electroencephalogram(EEG) recordings are possible. Flower MJ. J Med Philos 1985;10:237-251From 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
http://www.anaesthetist.com/icu/pain/Findex.htm#pain3.htmProbably the most significant discovery ever in the field ofpain has been the gene c-fos.The cellular analogue of a viral oncogene, this ratherspecial gene and its cellular product, the protein called Fosseem crucial to the profound central nervoussystem changes that occur when an animal (orman) feels pain.Central nervous system c-fos expressioncorrelates extremely well with painfulstimulation. Generically, Fos is one of the inducibletranscription factors (ITFs) that controls mammalian geneexpression.
We now have a molecular marker for pain!Even more important, we know thatbecause c-fos is a proto-oncogene - thatis, it can promote vast intracellular changesincluding cellular restructuring andproliferation - it is almost certainly involved in the long-term neurological consequences ofnoxious stimulation.
FOS has been found inthe fetal bones at leastas early as the 16thweek of gestation.