Pain in Neonates: (v. 10 Pain Research and Clinical Management)

Little attention has in the past been given to physiological or pathological responses of the infant to stimuli that produce pain in older individuals. All that has changed. Drs. Anand and McGrath have joined in writing and editing this collection of chapters on many aspects of nociception and the responses within the central nervous system, behavioral responses, endocrine, cardiovascular and immune functions. The question of the benefits of some pain to communicate the presence of a potentially dangerous event is the subject of a thoughtful discussion in Chapter 4. Nociception may trigger appropriate physiological responses. However, severe responses may in themselves be deleterious as documented by the improved outlook when they are blocked during surgery. The principles and pharmacotherapy with systemic analgesic drugs (especially opioids) is given extensive and informative consideration in Chapters 5 and 6. Regional and topical anesthesia in newborn infants is thoroughly covered in Chapter 7. A welcome addition to the discussions in first chapters of the book, is the report of experienced neonatal nurses on individualized supportive care to reduce pain and stress in neonatal intensive care units. They provide a critical review of studies of behaviors of preterm and sick infants, which they augment with a description of current practices. The remaining topics that serve to broaden the perspective of those caring for infants are indicated by the chapter titles: "Moral and ethical issues in clinical practice", "Research design and research ethics", "Social and legal issues", and finally, "Future directions" by the editors. Both editors have conducted extensive clinical research, much of which is reviewed in this remarkable textbook. This book, literally, opens the field of understanding pain in infancy, and offers a prescription for more ways to optimize care of newborn infants; it will surely stimulate further study of their neurologic responses.

Table of Contents:
Preface to the First Edition, by M.E. Avery. Dedication. Acknowledgements. List of contributors. 1. An overview of neonatal pain (B.J. Stevens, K.J.S. Anand). 2. Development of the peripheral and spinal pain system (M. Fitzgerald). 3. Development of supraspinal pain processing (V. Coskun, K.J.S. Anand). 4. Long-term consequences of pain in human neonates (R.E. Grunau). 5. Behavioral and neuroendocrine consequences of neonatal stress (P.M. Plotsky, C.C. Bradley, K.J.S. Anand). 6. Pain assessment in neonates (B. Stevens, C. Johnston, S. Gibbins). 7. Pharmacokinetics and pharmacodynamics of analgesic drugs (K.T. Olkkola, K. Hamunen). 8. Systemic analgesic therapy (K.J.S. Anand, G. Menon, U. Narsinghani, N. McIntosh). 9. Regional anesthesia and analgesia (N.F. Sethna, J.L. Koh). 10. Environmental and behavioral strategies to prevent and manage neonatal pain (L.S. Franck, g. Lawhon). 11. Fetal pain and stress (N. Modi, V. Glover). 12. The ethics of pain control in neonates and infants (G.A. Walco, R.C. Cassidy). 13. Neonatal pain in a social context (P.J. McGrath, A.M. Unruh). 14. Evidence-based decision making, systematic reviews and the Cochrane collaboration: implications for neonatal analgesia (A. Ohlsson, A. Taddio, A.R. Jadad, B.J. Stevens). Subject index.