Abstract
Limited understanding of infant pain has led to its lack of recognition in clinical practice. While the network of brain regions that encode the affective and sensory aspects of adult pain are well described, the brain structures involved in infant nociceptive processing are completely unknown, meaning we cannot infer anything about the nature of the infant pain experience. Using fMRI we identified the network of brain regions that are active following acute noxious stimulation in newborn infants, and compared the activity to that observed in adults. Significant infant brain activity was observed in 18 of the 20 active adult brain regions but not in the infant amygdala or orbitofrontal cortex. Brain regions that encode sensory and affective components of pain are active in infants, suggesting that the infant pain experience closely resembles that seen in adults. This highlights the importance of developing effective pain management strategies in this vulnerable population.
Highlights
The network of brain regions that encode both the affective and sensory aspects of the pain experience have been well described in the adult (Apkarian et al, 2005; Tracey and Mantyh, 2007)
Nociceptive information can be processed in the infant brain without a concomitant behavioural response (Slater et al, 2008), and interventions thought to alleviate pain can reduce clinical pain scores without reducing evoked nociceptive brain activity (Slater et al, 2010a). While these studies confirm that the infant central nervous system can process noxious stimulation, they do not elucidate the nature of the infant experience—in particular, which brain regions are involved, and whether the sensory, cognitive, and emotional aspects of pain are present in this population
Application of the stimuli evoked visible withdrawal of the stimulated leg, which could be observed at all stimulus intensities, whereas in adults, reflex withdrawal of the leg or foot was not observed at any stimulus intensity
Summary
The network of brain regions that encode both the affective and sensory aspects of the pain experience have been well described in the adult (Apkarian et al, 2005; Tracey and Mantyh, 2007). Nociceptive information can be processed in the infant brain without a concomitant behavioural response (Slater et al, 2008), and interventions thought to alleviate pain (i.e., oral sucrose) can reduce clinical pain scores without reducing evoked nociceptive brain activity (Slater et al, 2010a). While these studies confirm that the infant central nervous system can process noxious stimulation, they do not elucidate the nature of the infant experience—in particular, which brain regions are involved, and whether the sensory, cognitive, and emotional aspects of pain are present in this population. Parents were present during the studies and no infants were withdrawn from the study after recruitment
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