Carbajal's paper (1) demonstrates the importance of newborn-mother
interaction even as an analgesic. This is a further demonstration of what
we described in our papers (2,3): multisensorial stimulation, offered by
an attentive caregiver, is analgesic in newborns. We gave this phenomenon
a dual explanation:
1. multisensorial stimulation activates gate control
(4) of pain transmission to the brain, creating competition between
painful and non painful stimuli: according with the gate control theory
the brain is not a passive receiver of nociceptive input, but can
influence the information received, deciding whether it is important
enough to record.
2. Newborns are very demanding and want to be
reassured, soothed and calmed [they also need to relate and interact]. We
concluded that we cannot continue considering pain only from the technical
point of view, treating heel-prick or venepuncture only with oral sugar,
sucking and topical analgesics, which only provide partial analgesia and
not almost complete disappearance of pain signs as does multisensorial
stimulation that we showed to be more effective than oral sugar.
Furthermore the technical approach is not ethical because it ignores the
needs of newborns for human presence, preferably the mother. Carbajal's
work is a further demonstration that newborns, including premature babies,
look for a reassuring presence when experiencing pain. This might be
surprising, but to the attentive observer they reveal an unsuspected
emotional world. Not only do they feel pain, but they are also capable of
suffering, distress, anxiety and fear. This needs to be considered in
neonatal analgesic treatment, even for extremely premature children, where
mothers are not always allowed to stay by them: it is mandatory for
caregivers to guarantee a reassuring presence during painful procedures:
newborns are exacting patients. They not only feel pain, they even suffer;
they request not only sugar or drugs, but a human presence nearby.
References:
1. Carbajal R, Soocramanien V, Couderc S, Ville Y: Analgesic effect of
breast feeding in term neonates: randomised controlled trial. BMJ
2003;326:13
2. Bellieni CV, Buonocore G, Nenci A, Franci N, Cordelli DM, Bagnoli F:
Sensorial saturation: an effective tool for heel-prick in preterm infants.
Biol Neonate 2001;80:15-18
3. Bellieni CV, Bagnoli F, Perrone S, Nenci A, Cordelli DM, Fusi M,
Ceccarelli S, Buonocore G: The effect of multi-sensory stimulation on
analgesia in term neonates: a randomized controlled trial. Pediatr Res.
2002 Apr;51(4):460-3
4. Melzack R, Wall PD: Pain mechanisms: a new theory. Science
1965;150(699):971-9
Carlo V Bellieni, MD
Competing interests:
None declared
Competing interests:
No competing interests
02 February 2003
Carlo V. Bellieni
M.D., Neonatal Intensive Care Unit
Duccio M Cordelli, Franco Bagnoli and Giuseppe Buonocore
Rapid Response:
Newborns are very demanding patiens
Sir,
Carbajal's paper (1) demonstrates the importance of newborn-mother
interaction even as an analgesic. This is a further demonstration of what
we described in our papers (2,3): multisensorial stimulation, offered by
an attentive caregiver, is analgesic in newborns. We gave this phenomenon
a dual explanation:
1. multisensorial stimulation activates gate control
(4) of pain transmission to the brain, creating competition between
painful and non painful stimuli: according with the gate control theory
the brain is not a passive receiver of nociceptive input, but can
influence the information received, deciding whether it is important
enough to record.
2. Newborns are very demanding and want to be
reassured, soothed and calmed [they also need to relate and interact]. We
concluded that we cannot continue considering pain only from the technical
point of view, treating heel-prick or venepuncture only with oral sugar,
sucking and topical analgesics, which only provide partial analgesia and
not almost complete disappearance of pain signs as does multisensorial
stimulation that we showed to be more effective than oral sugar.
Furthermore the technical approach is not ethical because it ignores the
needs of newborns for human presence, preferably the mother. Carbajal's
work is a further demonstration that newborns, including premature babies,
look for a reassuring presence when experiencing pain. This might be
surprising, but to the attentive observer they reveal an unsuspected
emotional world. Not only do they feel pain, but they are also capable of
suffering, distress, anxiety and fear. This needs to be considered in
neonatal analgesic treatment, even for extremely premature children, where
mothers are not always allowed to stay by them: it is mandatory for
caregivers to guarantee a reassuring presence during painful procedures:
newborns are exacting patients. They not only feel pain, they even suffer;
they request not only sugar or drugs, but a human presence nearby.
References:
1. Carbajal R, Soocramanien V, Couderc S, Ville Y: Analgesic effect of
breast feeding in term neonates: randomised controlled trial. BMJ
2003;326:13
2. Bellieni CV, Buonocore G, Nenci A, Franci N, Cordelli DM, Bagnoli F:
Sensorial saturation: an effective tool for heel-prick in preterm infants.
Biol Neonate 2001;80:15-18
3. Bellieni CV, Bagnoli F, Perrone S, Nenci A, Cordelli DM, Fusi M,
Ceccarelli S, Buonocore G: The effect of multi-sensory stimulation on
analgesia in term neonates: a randomized controlled trial. Pediatr Res.
2002 Apr;51(4):460-3
4. Melzack R, Wall PD: Pain mechanisms: a new theory. Science
1965;150(699):971-9
Carlo V Bellieni, MD
Competing interests:
None declared
Competing interests: No competing interests