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The Effects of Early Pain Experience in Neonates on Pain Responses in Infancy and Childhood

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Abstract

Iatrogenic pain is commonplace in newborn infants yet we know very little about its long-term effects. This article reviews the evidence for and against the suggestion that painful procedures experienced in the perinatal period influence subsequent pain responses in infancy or in childhood.

The evidence suggests that early experiences with pain are associated with altered pain responses later in infancy. The direction of the altered response depends, in part, on the infant’s developmental stage (full-term vs preterm), and his or her cumulative experience with pain. Preterm infants that are hospitalized as neonates and subjected to painful procedures appear to have a dampened response to painful procedures later in infancy. Full-term neonates exposed to extreme stress during delivery, or to a surgical procedure, react to later noxious procedures with heightened behavioral responsiveness. Studies in which analgesic agents (local anesthetics or opioids) have been administered prior to noxious procedures demonstrate less procedural pain and a reduction in the magnitude of long-term changes in pain behaviors.

The precise determinants of these changes, their extent, and their permanence are not known but they appear to involve noxious stimulus-induced peripheral and central sensitization, as well as classical conditioning.

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Acknowledgments

Dr Taddio is supported by a New Investigator Award from the Canadian Institutes of Health Research. Dr Katz is supported by a Canada Research Chair in Health Psychology at York University, Toronto, Ontario, Canada. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Pharmacy and Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada

    Anna Taddio

  2. Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada

    Anna Taddio

  3. Department of Psychology and School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada

    Joel Katz

  4. Department of Anesthesia and Pain Management, Toronto General Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada

    Joel Katz

  5. Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada

    Joel Katz

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  1. Anna Taddio
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  2. Joel Katz
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Correspondence to Joel Katz.

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Taddio, A., Katz, J. The Effects of Early Pain Experience in Neonates on Pain Responses in Infancy and Childhood. Pediatr-Drugs 7, 245–257 (2005). https://doi.org/10.2165/00148581-200507040-00004

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