Fran Lang Porter

Long-term effects of pain in infants

Pain and stress have been shown to induce significant physiological and behavioral reactions in newborn infants, even in those born prematurely. Infants who are born prematurely or seriously ill are commonly exposed to multiple painful and stressful events as part of their prolonged hospitalizations and required medical procedures. There is now evidence that these early events not only induce acute changes, but that permanent structural and functional changes may also result. This article reviews the growing body of evidence of likely long-term effects of early pain and stress on the human infant. It is hoped that a better understanding of this literature will promote more responsive and sensitive management of infants and young children during their encounters with the medical community and will ultimately facilitate the healthy growth and development of all children.

Comparison of Fentanyl/Midazolam With Ketamine/Midazolam for Pediatric Orthopedic Emergencies

Objective. Emergency management of pediatric fractures and dislocations requires effective analgesia, yet childrens pain is often undertreated. We compared the safety and efficacy of fentanyl- versus ketamine- based protocols. Methodology. Patients 5 to 15 years of age needing emergency fracture or joint reduction (FR) were randomized to receive intravenous midazolam plus either fentanyl (F/M) or ketamine (K/M). Measures of efficacy were observational distress scores and self- and parental-report. Measures of safety were frequency of abnormalities in and need for support of cardiopulmonary function and other adverse effects. Results. During FR, K/M subjects (n = 130) had lower distress scores and parental ratings of pain and anxiety than did F/M subjects (n = 130). Although both regimens equally facilitated reductions, deep sedation, and procedural amnesia, orthopedists favored K/M. Recovery was 14 minutes longer for K/M. Fewer K/M subjects had hypoxia (6% vs 25%), needed breathing cues (1% vs 12%), or required oxygen (10% vs 20%) than did F/M subjects. Two K/M subjects required assisted ventilation briefly. More K/M subjects vomited. Adverse emergence reactions were rare but equivalent between regimens. Conclusions. During emergency pediatric orthopedic procedures, K/M is more effective than F/M for pain and anxiety relief. Respiratory complications occurred less frequently with K/M, but respiratory support may be needed with either regimen. Both regimens facilitate reduction, produce amnesia, and rarely cause emergence delirium. Vomiting is more frequent and recovery more prolonged with K/M.

Dementia and response to pain in the elderly

&NA; To investigate the effect of dementia on response to pain, 51 community‐dwelling, generally healthy, cognitively intact individuals ≥ 65 years old and 44 community‐ or nursing home‐dwelling persons ≥ 65 years old with varying severity of dementia were studied. Cognitive status was assessed by standardized clinical evaluation and psychometric test performance. The following responses were measured before, during and after a standard venipuncture procedure: heart rate, the amplitude of respiratory sinus arrhythmia (RSA), self‐reported anxiety and pain, and videotaped facial expressions. Although RSA did not differentiate procedural phases, in both samples, mean heart rate increased in the preparatory phase and decreased in the venipuncture phase. Independent of age, increasing severity of dementia was associated with blunting of physiologic response as measured by diminished heart rate increase in the preparatory phase and heart rate increase with venipuncture. Dementia significantly interfered with the subjects ability to respond to direct questions about anxiety and pain. Those who were able to respond were relatively accurate self‐assessors: higher anxiety was associated with greater magnitude heart rate responses. Facial expression was increased in demented individuals but it could not be classified by specific emotions. We conclude that dementia influences both the experience and reporting of pain in elderly individuals.

Circumcision: II. Effects upon mother-infant interaction

The effects of circumcision upon mother-infant interaction were examined in an observational study of 59 mother-infant pairs during hospital feedings on days 2 and 3 of life. Each pair was observed during 4 hospital feedings using a specifically designed mother-infant interaction observation system that examined 43 discreet behaviours relating to feeding, gaze, facial expression, vocalizations and touch. The experimental group was circumcised after the second feeding and the control group after the fourth feeding. Analysis revealed no major behavioral differences between the experimental and control groups. Yet, different trends between the two groups were observed regarding two variables shortly after surgery. These differences disappeared by 24 h post-operatively. Differences related to the frequency of feeding intervals and infant availability scores. The study also revealed a surprisingly limited repertoire of behavior exhibited by both the mother and infant during feeding sessions. Our data suggest that circumcision has brief and transitory effects on mother-infant interactions observed during hospital feeding sessions, the only time mothers who are not rooming-in have an opportunity to be with their infants.

Self-monitoring of progress in weight-reduction: A preliminary report☆

This paper reports a weight-graphing technique which combines feedback with goal-setting and thus makes progress toward goal weight salient. The technique was used by 11 individuals who lost a mean of 9.6 lb in a mean of 39 days. These results are within the range of those obtained with more comprehensive treatments, suggesting that well-chosen feedback as to progress toward naturally-occurring rewards may be an effective change influence.