The importance of ‘awareness’ for understanding fetal pain

@article{Mellor2005TheIO,
  title={The importance of ‘awareness’ for understanding fetal pain},
  author={D. Mellor and T. Diesch and A. Gunn and L. Bennet},
  journal={Brain Research Reviews},
  year={2005},
  volume={49},
  pages={455-471}
}
Our understanding of when the fetus can experience pain has been largely shaped by neuroanatomy. However, completion of the cortical nociceptive connections just after mid-gestation is only one part of the story. In addition to critically reviewing evidence for whether the fetus is ever awake or aware, and thus able to truly experience pain, we examine the role of endogenous neuro-inhibitors, such as adenosine and pregnanolone, produced within the feto-placental unit that contribute to fetal… Expand
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References

SHOWING 1-10 OF 286 REFERENCES
For Debate: Reflex responses do not necessarily signify pain
Can a fetus feel pain? This question is appropriate, as medical interventions during pregnancy,1 fetal surgery,2 and possibly termination of pregnancy expose the fetus to noxious stimuli. To answerExpand
Locating the beginnings of pain.
TLDR
The major moral implication of this stance is to place the burden of proof for analgesic use onto clinical measures, rather than relying upon the, so far, poorly supported assumption of pain awareness. Expand
A Pain in the Fetus: Toward Ending Confusion About Fetal Pain
TLDR
The problem of determining when, in its development, a human becomes capable of feeling pain is elucidated and the available data are examined showing how, on balance, it tends more to support than undermine the claim that fetuses of around 28 to 30 weeks' gestation are capable of Feeling pain. Expand
Pain and stress in the human fetus.
  • M. White, A. Wolf
  • Medicine
  • Best practice & research. Clinical anaesthesiology
  • 2004
TLDR
If the technique of fetal surgery is to progress then a greater understanding of nociception and the stress response is required, and the optimal amount of suppression required and the best method of achieving this remain unknown. Expand
Book Review: The Neurobiology of Pain: Developmental Aspects
  • M. Fitzgerald, S. Beggs
  • Medicine
  • The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry
  • 2001
TLDR
Sensory responses to invasive procedures in the immature nervous system are discussed and it is highlighted that early damage in infancy can lead to prolonged structural and functional alterations in pain pathways that can last into adult life. Expand
The Neurobiology of Infant Pain: Development of Excitatory and Inhibitory Neurotransmission in the Spinal Dorsal Horn
TLDR
Pain from invasive procedures in intenive care and postoperative pain and pain from isease and trauma are still poorly managed in inants and children, and when analgesics are precribed, there are little data on their effectiveness. Expand
Fetal pain: implications for research and practice
TLDR
To address the question of pain in the fetus, one must use indirect evidence from a variety of sources, and then make an informed guess, similar to that which is used with animals with animals. Expand
Labor analgesia and infant brain development
  • M. Golub
  • Medicine
  • Pharmacology Biochemistry and Behavior
  • 1996
TLDR
A series of studies has recently been completed using a rhesus monkey model for administration of labor analgesia under controlled experimental conditions and long-term behavioral evaluation of infants, which confirmed the neonatal depressant effects of meperidine and suggested that the course of behavioral maturation during certain periods of infancy is influenced by both me peridine and bupivacaine administration at birth. Expand
Behavior, pain perception, and the extremely low-birth weight survivor.
This article explores the literature concerning responses to pain of both premature and term-born newborn infants, the evidence for short-term and long-term effects of pain, and behavioral sequelaeExpand
Effects of perinatal pain and stress.
  • K. Anand
  • Medicine
  • Progress in brain research
  • 2000
TLDR
Advances in the study of repetitive pain associated with routine NICU care have challenged the perspective that prolonged pain and stress were inevitable consequences of premature birth, and forced clinicians to reconsider the risk-benefit ratios for such therapy. Expand
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