FETAL PAIN
30 Years of Life-Saving Science
8 weeks
Unborn and Newborn PainCirca 1978
General belief – Unborn and Newborn did not “Feel” pain
No analgesia for newborn circumcisionNo anesthesia for newborn or neonatal surgeryMain method of surgical anesthesia:
Adhesive Tape
Fetal PainAnd Abortion:The Medical
Evidence By:
Vincent J. Collins, MDSteven R. Zielinski, MD
Thomas J. Marzen, Esq. AMERICANS
UNITED FOR LIFELegal Defense Fund
Law and Medicine Series
1984
Pain: an unpleasant sensory
and emotional experience associated with actual or potential tissue damage
or described in terms of such damage.
Animal Pain – Perception and AlleviationKitchell, R.L., Erickson, H.H., eds.Bethesda, MD.:American Physiological Soc., 1983
Essential Elements
Structure
Function
Aversive Response toA Noxious Stimulus
Nociceptors
Brain Structures
Nerve Pathways
STRUCTURE:WHAT YOU NEED:
Nociceptors Look like small bushes or the frayed end of a rope
Respond to pressure, heat,or cold
Nerve Pathways
Nerves gather into TRACTS That enter Dorsal Hornof the Spinal Cord and go up
Brain Structures
THALAMUS
Central processing center for sensory information
FUNCTION
ELECTRICAL ACTIVITY
Present at 40 days
A recognizable EEG at 19-20 weeks
NEUROTRANSMITTERS
HORMONES
Substance P, Glutamate, CGRP, VIP
Cortisol, Norepinephrine
AVERSIVE RESPONSE TO 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
From 16 weeks gestation, the typical change in brain circulation is seen in the fetal brain in response to a painful stimulus.
Wladimiroff JW et. al. Obstet Gynecol 1987;69:705-9
Hormonal stress responses to painful stimuli as early as 16 weeks gestational age, possibly sooner.
NOT JUST PRESENCE, BUT CHANGE
Cardiovascular responses such as increases in blood pressure and heart rate, abnormal heart rhythms, or poor cardiac output.
Anesthesia blunts these responses
EXCUSESCan't speak, can't feel pain.
ReflexNo myelin - no pain.
No Cortex
Minimal or incomplete response
No memory
Decorticate and Decerebrate Rigidity
Stressed-out, or in (utero)? http://www.med.upenn.edu/ins/Journal%20Club/08-09/Fall%202008/Tallie%20Z.%20Baram/tins02.pdf
Abstract…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 might promote hippocampal-dependent cognitive function, whereas severe stress might impair neuronal function and survival, both immediately and in the long-term. Importantly, these CRH-mediated processes could be targets of preventive and interventional strategies.
RELIGION
DARWIN
FETALPAIN
At 20 weeks, the fetal brain has the full complement of neurons present in adulthood.
Lagercrantz H et. al. Lakartidningen 1991;88:1880-85
By 19-20 weeks, the earliest electroencephalogram(EEG) recordings are possible.
Flower MJ. J Med Philos 1985;10:237-251
From 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
CONSCIOUSNESS
A simple definition of consciousness is sensory awareness of the body, the self, and the world.
REMEMBRANCE
Dr. Vincent Collins
Thomas J. Marzen, Esq.
http://www.anaesthetist.com/icu/pain/Findex.htm#pain3.htm
Probably the most significant discovery ever in the field of pain has been the gene c-fos.
The cellular analogue of a viral oncogene, this rather special gene and its cellular product, the protein called Fos seem crucial to the profound central nervous system changes that occur when an animal (or man) feels pain.
Central nervous system c-fos expression correlates extremely well with painful stimulation. Generically, Fos is one of the inducible transcription factors (ITFs) that controls mammalian gene expression.
We now have a molecular marker for pain! Even more important, we know that because c-fos is a proto-oncogene - that is, it can promote vast intracellular changes including cellular restructuring and proliferation
- it is almost certainly involved in the long-term neurological consequences of noxious stimulation.
FOS has been found in the fetal bones at least as early as the 16th week of gestation.
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