Infants and pain

February 11, 1992

Think back to medical practices of earlier eras and many of them now seem barbaric, futile or even silly -- amputations with little more than a shot of alcohol to ease the pain, bleeding sick people with leeches. But not all of those questionable practices are ancient history. Last month, the New England Journal of Medicine published a study indicating that doctors who minimize the use of anesthetics during surgery on infants may well be endangering their young patients' lives.

For many years, surgery was performed on infants with little or no pain relief because doctors feared that the medication would dangerously suppress the child's blood pressure. Moreover, there was doubt that the infants felt pain as older people do -- or that it would have any lasting effects. Light anesthesia -- enough to make a child unconscious, but not enough to keep its body from sensing pain and reacting to it -- is still common, even though narcotics have been developed that make deep anesthesia safe for infants.

The recent study, which compared the effects of deep and light anesthesia on babies, uncovered distinct advantages in protection from pain. Researchers found that pain took a measurable toll on the lightly anesthetized babies. Their bodies produced high levels of stress hormones, they were more prone to infections, their blood clotted unnecessarily and acid built up in their muscle tissue.

The bottom line: Of 15 babies who received only light anesthesia, four died, while all 30 receiving deep anesthesia survived. Pain, it seems, can carry its own risks and these risks should be taken into account in making decisions about medications to relieve pain.

Only a few years ago, the preparation of a tiny infant for surgery wasn't much different from "roping and holding down a steer to brand it," as one Hopkins physician described it. But now that safe narcotics are available and research has proven that pain can be life threatening, there is no reason to perform surgery on sick infants with practices that now seem, in fact, barbaric.

Despite the recent study, the medical community has a long way to go in its approach to pain -- for both infants and adults. Other studies have shown that the pain experienced by the vast majority of sick children is under-treated, if it is treated at all. The same holds true in surveys of adult cancer patients.

Do some doctors assume that pain is good for us or that it is insignificant compared to other problems? If that's the case, recent pain research is proving them wrong. The survival rate of sick infants who were protected from pain carries a message that begs to be heard.

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