Neonatal Plasticity of the Nociceptive System: Mechanisms, Effects, and Treatment of Repetitive Painful Procedures During NICU Admittance

Author(s): N.J. van den Hoogen*, J. Patijn, D. Tibboel, E.A. Joosten

Journal Name: Current Pharmaceutical Design

Volume 23 , Issue 38 , 2017


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Abstract:

Introduction: In the Neonatal Intensive Care Unit (NICU), prematurely born infants undergo a range of skin breaking and painful procedures. At the same time, the spinal nociceptive system is in a sensitive developmental stage. Both neonatal repetitive painful procedures and their treatment can induce plasticity of the neonatal spinal nociceptive system, causing long-lasting alterations to pain processing and pain reactivity.

Methods: This review focuses on developmental processes related to the nociceptive network in the spinal dorsal horn and more specifically at mechanisms related to 1. Modulation of afferent systems; 2. The role of interneurons; 3. Descending inhibitory pathways; and 4. The central neuro-immune responses and microglial cell responses. The effects and possible mechanisms underlying the long-term effects of repetitive painful procedures on the developing nociceptive system as well as subsequent pharmacological treatment (acetaminophen, morphine) in early life are discussed.

Results: Repetitive stimulation of the nociceptive system in a rat model with use of needle pricks in the hind-paw closely mimics the clinical situation for infants in the NICU.

Conclusion: Activity dependent plasticity in early postnatal life induces long-lasting alterations that then may cause altered pain perception in adulthood. For a future choice of optimal analgesic drugs these considerations have to be taken into account beyond the classical classes of drugs used nowadays.

Keywords: Neonatal pain, NICU, repetitive pain, long-term effects, plasticity, analgesic drugs.

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Article Details

VOLUME: 23
ISSUE: 38
Year: 2017
Published on: 09 February, 2018
Page: [5902 - 5910]
Pages: 9
DOI: 10.2174/1381612823666170921130320
Price: $65

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