Abstract
Neonatal pain experiences have been associated with altered processing and perception
of pain in later life, but findings tend to vary among studies. We have compared experimental
pain tolerance and subjective health complaints in a population-based cohort of adolescents
born extremely preterm to that of matched term controls. Subjects performed a standardized
cold pressor task (hand in ice water) and completed validated questionnaires regarding
current subjective health complaints, including pain issues. Thirty-one (89%) of 35
eligible preterm subjects (mean gestational age 26.8 weeks) and 28 (80%) term controls
participated in this follow-up study at mean age 17.8 years. Ten (32%) subjects born
preterm versus 17 (61%) born at term reached the ceiling time of 180 seconds immersion
time in the ice water, a hazard ratio for early withdrawal of 2.05 (95% confidence
interval, 1.72 to 2.44), with males explaining most of the difference. For subjects
born preterm, the risk of early withdrawal decreased significantly with more days
of mechanical ventilation, more pain events, and more doses of morphine during the
newborn period. Subjective pain ratings during the cold pressor task as well as health-related
complaints and pain issues reported in the questionnaires were similar in the preterm
and term groups.
Perspective
Despite reduced tolerance to experimental pain, subjects born preterm scored their
pain experiences similarly to those of term controls. Surprisingly, preterm subjects
exposed to most painful and invasive neonatal experiences and also to most doses of
morphine had a pain response at follow-up most closely resembling that of the control
group.
Key words
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References
- Summary proceedings from the neonatal pain-control group.Pediatrics. 2006; 117: S9-S22
- Pain and its effects in the human neonate and fetus.N Engl J Med. 1987; 317: 1321-1329
- Can adverse neonatal experiences alter brain development and subsequent behavior?.Biol Neonate. 2000; 77: 69-82
- Cutaneous flexion reflex in human neonates: A quantitative study of threshold and stimulus-response characteristics after single and repeated stimuli.Dev Med Child Neurol. 1999; 41: 696-703
- Self-Efficacy. The Exercise of Control.W.H. Freeman and Company, New York, NY1997 (pp 259-318)
- Cognitive and behavioral outcomes of school-aged children who were born preterm: A meta-analysis.JAMA. 2002; 288: 728-737
- Characteristics and prediction of early pain after laparoscopic cholecystectomy.Pain. 2001; 90: 261-269
- Pain sensitivity in prematurely born adolescents.Arch Pediatr Adolesc Med. 2003; 157: 1079-1082
- The impact of maternal behavior on children’s pain experiences: An experimental analysis.J Pediatr Psychol. 2002; 27: 293-301
- Aerobic capacity and exercise performance in young people born extremely preterm.Pediatrics. 2012; 129: e97-e105
- The Health Behaviour in School-aged Children: WHO Collaborative Cross-National (HBSC) study: Origins, concept, history and development 1982-2008.Int J Public Health. 2009; 54: 131-139
- Long-term effects of routine morphine infusion in mechanically ventilated neonates on children’s functioning: Five-year follow-up of a randomized controlled trial.Pain. 2011; 152: 1391-1397
- The development of nociceptive circuits.Nat Rev Neurosci. 2005; 6: 507-520
- Postnatal development of the cutaneous flexor reflex: Comparative study of preterm infants and newborn rat pups.Dev Med Child Neurol. 1988; 30: 520-526
- Infant pain traces.Pain. 2006; 125: 204-205
- Infant pain management: A developmental neurobiological approach.Nat Clin Pract Neurol. 2009; 5: 35-50
- Preterm births: Can neonatal pain alter the development of endogenous gating systems?.Eur J Pain. 2008; 12: 945-951
- Early pain in preterm infants. A model of long-term effects.Clin Perinatol. 2002; 29: 373-394
- Long-term consequences of pain in human neonates.Semin Fetal Neonatal Med. 2006; 11: 268-275
- Demographic and therapeutic determinants of pain reactivity in very low birth weight neonates at 32 Weeks’ postconceptional Age.Pediatrics. 2001; 107: 105-112
- Children’s judgements about pain at age 8-10 years: Do extremely low birthweight (< or = 1000 g) children differ from full birthweight peers?.J Child Psychol Psychiatry. 1998; 39: 587-594
- Early pain experience, child and family factors, as precursors of somatization: A prospective study of extremely premature and fullterm children.Pain. 1994; 56: 353-359
- Better care of immature infants; has it influenced long-term pulmonary outcome?.Acta Paediatr. 2006; 95: 547-554
- A critical period in the supraspinal control of pain: Opioid-dependent changes in brainstem rostroventral medulla function in preadolescence.Pain. 2012; 153: 775-783
- Subjective health complaints in adolescence-reliability and validity of survey methods.J Adolesc. 2001; 24: 611-624
- Relieving the pressure? The role of physical activity in the relationship between school-related stress and adolescent health complaints.Res Q Exerc Sport. 2003; 74: 127-135
- Long-term alteration of pain sensitivity in school-aged children with early pain experiences.Pain. 2006; 125: 278-285
- Chronic idiopathic pain in adolescence–high prevalence and disability: The young HUNT study 2008.Pain. 2011; 152: 2259-2266
- Responses to pain in school-aged children with experience in a neonatal intensive care unit: Cognitive aspects and maternal influences.Eur J Pain. 2009; 13: 94-101
- Behavioral responses to pain are heightened after clustered care in preterm infants born between 30 and 32 weeks gestational age.Clin J Pain. 2006; 22: 757-764
International Association for the Study of Pain and. http://www.iasp-pain.org/. 2011. International Association for the Study of Pain. Ref Type: Electronic Citation.
- The fragile male.BMJ. 2000; 321: 1609-1612
- Long-term impact of neonatal injury in male and female rats: Sex differences, mechanisms and clinical implications.Front Neuroendocrinol. 2010; 31: 193-202
- Perceived self-efficacy in health behaviour research: Conceptualisation, measurement and correlates.Psychol Health. 2000; 15: 51-69
- Prediction of neurodevelopmental and sensory outcome at 5 years in Norwegian children born extremely preterm.Pediatrics. 2011; 127: e630-e638
- The general self-efficacy scale: Multicultural validation studies.J Psychol. 2005; 139: 439-457
- Relationship between significant perinatal events and migraine severity.Pediatrics. 2005; 116: e555-e558
- Early death, morbidity, and need of treatment among extremely premature infants.Pediatrics. 2005; 115: 1289-1298
- Neurologic and developmental disability at six years of age after extremely preterm birth.N Engl J Med. 2005; 352: 9-19
- Temperature and the cold pressor test.J Pain. 2004; 5: 233-237
- Major surgery within the first 3 months of life and subsequent biobehavioral pain responses to immunization at later age: A case comparison study.Pediatrics. 2003; 111: 129-135
- Does neonatal surgery lead to increased pain sensitivity in later childhood?.Pain. 2005; 114: 444-454
- Socio-economic inequality in preterm birth: A comparative study of the Nordic countries from 1981 to 2000.Paediatr Perinat Epidemiol. 2009; 23: 66-75
- Role of gender norms and group identification on hypothetical and experimental pain tolerance.Pain. 2007; 129: 122-129
- Prolonged sedation and/or analgesia and 5-year neurodevelopment outcome in very preterm infants: Results from the EPIPAGE cohort.Arch Pediatr Adolesc Med. 2008; 162: 728-733
- Long-term consequences of early infant injury and trauma upon somatosensory processing.Eur J Pain. 2007; 11: 799-809
- Is general self-efficacy a universal construct? Psychometric findings from 25 countries.Eur J Psychol Assess. 2002; 18: 242-251
- The cerebral signature for pain perception and its modulation.Neuron. 2007; 55: 377-391
- Sensitization, somatization, and subjective health complaints.Int J Behav Med. 1997; 4: 105-116
- Endpoints in pediatric pain studies.Eur J Clin Pharmacol. 2010; 67: 61-66
- Health related quality of life after extremely preterm birth: A matched controlled cohort study.Health Qual Life Outcomes. 2010; 8: 53
- Guidelines for the cold pressor task as an experimental pain stimulus for use with children.J Pain. 2005; 6: 218-227
- Long-term impact of neonatal intensive care and surgery on somatosensory perception in children born extremely preterm.Pain. 2009; 141: 79-87
- Normative model for cold pressor test.Am J Phys Med Rehabil. 1989; 68: 6-11
- The impact of maternal negative affectivity and general self-efficacy on breastfeeding: The Norwegian Mother and Child Cohort Study.J Pediatr. 2008; 152: 68-72
Article info
Publication history
Accepted:
July 11,
2012
Received in revised form:
June 20,
2012
Received:
March 14,
2012
Footnotes
The study was kindly supported financially by the Western Norway Regional Health Authority and the University of Bergen. The authors declare that they have no conflicts of interest.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
