Are there opportunities to decrease nosocomial infection by choice of analgesic regimen? Evidence for immunity and pain interactions.
BACKGROUND
Interactions suggest that anesthetic and analgesic strategies could be used to modulate immune function and reduce nosocomial infection in critically ill pediatric patients. However, this theory has yet to be adequately tested.


OBJECTIVE
To present the evidence for interactions between nociceptive and immune pathways.


METHODS
The MEDLINE database and hand searches of the English-language biomedical literature for the 1985-2003 period.


RESULTS
Substantial evidence exists for numerous bidirectional relationships between nociceptive and immune pathways. Some studies suggest that surgical pain and stress may alter immune function in adults. Limited evidence indicates that anesthetic and analgesic immunomodulation may boost immune function to prevent nosocomial infection. However, unique aspects of immune function maturation and neurodevelopment must be considered.


CONCLUSIONS
Research is urgently needed to determine if the interactions between nociceptive and immune function pathways in critically ill infants and children are similar to those in adults and if host defenses can be enhanced by optimal anesthetic and analgesic strategies.
Weatherstone
Kathleen B
KB
Department of Pediatrics, University of Kansas School of Medicine, Kansas City, KS 66160-7358, USA. kweather@kumc.edu
Franck
Linda S
LS
Klein
Nigel J
NJ
D000698:Analgesia / Q000379:methods*; D000758:Anesthesia / Q000379:methods*; D016638:Critical Illness; D003428:Cross Infection / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D010147:Pain Measurement; D010372:Pediatrics