We retrieved only one article where PMP was performed in PMI for clinical reasons (venipuncture) in 13 more studies, pain was experimentally provoked by noxious stimuli such as heat, electricity, or arm mobilization. We retrieved 46 studies that exposed NI to PMP only in 14.2% of the studies, a validated analgesic treatment was administered to the control group. We performed a Medline search to retrieve the studies published in 20, in which NI and PMI underwent PMP. We examined those trials in which patients undergo painful minor procedures (PMP) because these procedures are frequent and severely stressful for NI and PMI.
We performed the present study to assess whether this also happens in clinical trials that should statutorily guarantee basic patients’ rights. People lacking judgmental ability (newborn infants and persons with mental impairment ) are reported to receive less analgesic treatments than people who can give adequate informed consent. This evidence becomes weaker before this date, though we cannot exclude its increasing presence since the beginning of the second half of the gestation.Īim. CONCLUSIONS: Most studies disclose the possibility of fetal pain in the third trimester of gestation. Against this possibility, some authors report the immaturity of the cortex with the consequent lack of awareness, and the almost continuous state of sleep of the fetus. In favor of a 2nd trimester perception of pain is the early development of spino-thalamic pathways (approximately from the 20th week), and the connections of the thalamus with the subplate (approximately from the 23rd week). But the presence of fetal pain in the 2nd trimester is less evident. Most endocrinological, behavioral and electrophysiological studies of fetal pain are performed in the third trimester, and they seem to agree that the fetus in the 3rd trimester can experience pain. RESULTS: We retrieved 217 papers of which 157 were highly informative some reported similar data or were only case-reports, and were not quoted.
We focused on: (a) fetal development of nociceptive pathways (b) fetal electrophysiological, endocrinological and behavioral reactions to stimuli and pain. MATERIAL AND METHODS: We performed a Medline research from 1995, matching the following key words: "pain" and "fetus", with the following: "subplate", "thalamocortical", "myelination", "analgesia", "anesthesia", "brain", "behavioral states", "substance p". Due to the progress in fetal surgery, it is important to acquire data about fetal pain.
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