Imagine premature babies actually having awareness to the extent where they consciously feel pain. This potentially revolutionary development in pain management is the result of research conducted by Kanwaljeet S. Anand, M.D., director of the Pain Neurobiology Laboratory at Arkansas Children's Hospital Research Institute (ACHRI), recipient of the Morris & Hettie Oakley endowed chair for critical care medicine and professor of pediatrics, anesthesiology, pharmacology, neurobiology and developmental sciences, University of Arkansas for Medical Sciences, College of Medicine, has submitted a research article regarding the response of premature babies to pain, that will be published in the medical journal Pain.
Until now, 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 spectroscopy, Anand studied the responses of babies by monitoring changes in heart rate, facial expressions and blood pressure through positive and negative stimuli. His findings support his initial theory on neonatal pain, first published in a landmark article in 1987.
"This is the first study to report that when a premature baby feels pain, that acute pain activates the sensory cortex, the highest center of pain processing in the brain," says Anand. "These results prove that babies consciously feel pain, rather than simply reacting to it." Anand says his most recent research is a culmination of what he proposed in the New England Journal of Medicine almost 20 years ago.
In the first phase of the most recent study, researchers put electrodes over the sensory cortical areas of the brain and made the babies comfortable, avoiding exposure to noise or light. After stimulating the babies' hands by stroking them with alcohol swabs, both sides of the babies' brains were stimulated, shown by increases in blood flow. Experienced nurses from the Neonatal Intensive Care Unit then inserted needles in the babies' veins to draw blood, resulting in a several-fold increase in blood flow to the sensory cortex, suggesting the babies felt pain at the highest sensory level of their brains.
The results of Anand's research were followed by criticism suggesting that all areas of the brain may be stimulated by pain, not just the sensory cortex. In response to the criticism, the trial was altered and repeated in another group of babies. Researchers then placed two electrodes: one over the sensory cortex and another over the visual cortex, which primarily reacts to visual stimuli and not sensory stimuli. There were, again, robust increases in blood flow to the sensory area but not to the visual area of the brain.
