Beyond Acute Pain: Understanding Chronic Pain in Infancy.
This topical review presents the current challenges in defining chronic pain in infants, summarizes evidence from animal and human infant studies regarding the biological processes necessary for chronic pain signaling, and presents observational/experiential evidence from clinical experts. A literature search of four databases (CINAHL, EMBASE, PsycINFO, and MEDLINE) was conducted, along with hand searches of reference lists. Evidence from animal studies suggest that important neurophysiological mechanisms, such as the availability of key neurotransmitters needed for maintenance of chronic pain, may be immature or absent in the developing neonate. In some cases, human infants may be significantly less likely to develop chronic pain. However, evidence also points to altered pain perception, such as allodynia and hyperalgesia, with significant injury. Moreover, clinicians and parents in pediatric intensive care settings describe groups of infants with altered behavioral responses to repeated or prolonged painful stimuli, yet agreement on a working definition of chronic pain in infancy remains elusive. While our understanding of infant chronic pain is still in the rudimentary stages, a promising avenue for the future assessment of chronic pain in infancy would be to develop a clinical tool that uses both neurophysiological approaches and clinical perceptions already presented in the literature.
Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada. mgdilo@yorku.ca.
Miranda
M
DiLorenzo
Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada. rpr@yorku.ca.|Department of Psychiatry, The Hospital for Sick Children and the Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada. rpr@yorku.ca.
Rebecca
R
Pillai Riddell
Department of Occupational Science and Occupational Therapy, B.C. Children's Hospital Research, Vancouver, BC, V5Z 4H4, Canada. liisa.holsti@ubc.ca.|Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada. liisa.holsti@ubc.ca.
Liisa
L
Holsti
NICU; acute; chronic; infant; pain; persistent pain