[Neuro- and psychophysiology of pain in children.].
In the past the view has often been expressed that children are less sensitive to pain than adults as a result of the assumption that their nervous system is not as well developed. According to this theory, newborns were not supposed to feel pain at all, and for this reason minor surgery was often performed with inadequate anesthesia. Evidence in the more recent literature and the regular choice of "pain in children" as a topic for congresses exemplify the more and more widespread belief that children of all ages can feel pain and, relative to their developmental stage, suffer accordingly. However, there are significant differences in the way children experience and react to pain in comparison to adults, e.g., because of the difference in ability to evaluate acute or chronic pain cognitively. At birth, all human sensory organs have developed far enough to be full functional-as a result of the long gestational period, which is far longer than most other mammalian species. The results of animal experiments and observations in newborns have led to the conclusion that in humans and other mammals, the sensory pain system is fully developed at birth. Pain-related reactions can be seen in the motor, vegetative and endocrine pain parameters, and in the infant's crying. As the experience of pain increases, conditioned avoidance reactions can be noted, as can the child's experience of psychosomatic pain reinforcement by the care-givers, e.g., when a crying child in pain receives more attention from the persons around it. In pre-school children, the level of pain can be measured using appropriate instruments, as demonstrated in cases of chronic arthritis. As cognition develops further, the patient's own concept of health and sickness changes, as does the ability to express feelings of pain. In the pathogenesis of pain in children, the dominant types are nociceptor pain (e.g., as a result of trauma or infection) and pain resulting from malfunction (e.g., physical malposition, migraine), whereas nervous pain occurs less frequently. Pediatricians should pay particular attention to the treatment of acute and chronic pain in children.
Zimmermann
M
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Abteilung für Physiologie des Zentralnervensystems, II. Physiologisches Institut der Universität, Im Neuenheimer Feld 326, D-6900, Heidelberg.