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Nature Cites Work of UAMS, ACHRI Pain Expert

Anand Research Advances Pain Relief for Premature Infants

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UAMS Medical Center

Nature Cites Work of UAMS, ACHRI Pain Expert

Anand Research Advances Pain Relief for Premature Infants

LITTLE ROCK – Observing the response to painful medical procedures by premature infants illustrates a need to provide more pain relief, according to a pain expert at the University of Arkansas for Medical Sciences (UAMS) and Arkansas Children’s Hospital Research Institute (ACHRI).

International scientific journal Nature pointed to the research of Dr. Kanwaljeet S. Anand, professor of pediatrics, anesthesiology, pharmacology and neurobiology in the UAMS College of Medicine and director of the Pain Neurobiology Laboratory at ACHRI, in an article in its Nov. 9 issue examining the debate over infant pain. Anand’s research reported responses to pain by premature babies, suggesting that the infants consciously perceived pain.

The Nature article noted that until about 20 years ago, premature infants did not receive any pain relief for medical or surgical procedures since it was unclear whether they could feel pain. Anand countered that not only is there evidence for infant pain, continued and repeated exposure to pain can lead to long-term problems with pain sensitivity.

“There is evidence for the conscious perception of pain, even in the smallest premature babies. We now have a moral imperative to provide pain relief,” Anand said in the article.

Until now, Anand said, the prevailing theory was that premature babies react to pain through reflex, but do not actually perceive pain beyond their nerve fibers or spinal cord, and certainly not in the highest sensory center of the brain. Using near infrared imaging, Anand and colleagues studied pain responses in the brains of two-day-old premature babies, correlated with changes in heart rate, blood pressure, and blood oxygen saturations through touch and pain stimuli.

Anand studied the preterm babies who required needle puncture of a vein for collecting blood samples as a part of medical care. Following the painful stimuli, more blood flowed to the part of the brain responsible for processing sensory stimulation from the body. Anand noted that the blood did not flow to the part of the brain responsible for processing information from visual stimuli, indicating this was a specific response to the pain.

The research of Anand and his colleagues was published in the May 2006 issue of the scientific journal Pain.

Anand affirmed his findings in an essay published in the June 2006 issue of Pain: Clinical Outcomes, a publication of the International Association for the Study of Pain, where he said evidence indicated that fetuses feel pain as early as the second trimester.

“Our current understanding of development provides the anatomical structures, the physiological mechanisms and the functional evidence for pain perception developing in the second trimester, certainly not in the first trimester, but well before the third trimester of human gestation,” said Anand, who is also the Morris and Hettie Oakley Chair in Critical Care Medicine in the UAMS College of Medicine, in Pain: Clinical Outcomes.

Anand said his research is continuing to examine situations where preterm infants are exposed to pain, such as post-operative pain and discomfort from being on a ventilator. The results could improve neonatal intensive care practices, said Anand, who is chairman of the Neonatal Pain-Control Group, a task force appointed by the National Institutes of Health (NIH) for developing research priorities in pain management.

In addition, Anand told Nature, he is extending his research to fetuses using non-invasive neuroimaging approaches. “As the technologies for brain imaging improve, the development and behavior of fetuses and premature babies will be less of a mystery,” Anand said.

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