Fetuses First Perceive Pain at 35 to 37 Weeks, Study Suggests

[Omaha Steve]

Blows the anti-abortion time line out of the water.

http://www.nationalpartnership.org/site/News2?abbr=daily4_&page=NewsArticle&id=30404&security=1521&news_iv_ctrl=-1

September 13, 2011 — Premature infants begin to discern pain from touch at about 35 to 37 weeks of gestation, about two to four weeks before typical delivery, according to a new study in the journal Current Biology, ABC News reports. The findings could shed light on a point of contention in the abortion-rights debate and potentially affect clinical care for preterm infants.

Researchers used electroencephalography to compare preterm infants' brain activity in response to a touch and a heel prick. Infants born at 28 to 35 weeks of development showed comparable brain activity for the touch and heel prick, but infants born at more than 35 weeks of gestation exhibited a greater response to the heel prick than the touch.


MORE at link.

[Nye Bevan]

1. I don't expect this to change many minds on the anti-choice side.

I don't think most in the anti-choice lobby take this position because they are concerned about the fetus feeling pain in an abortion. Because then their objection could be met simply by legislating that the fetus be anesthetized prior to the procedure. I think it's more that they believe that abortion is wrong even if the fetus feels no pain.

[Warpy]

3. No, this just confirms earlier research that found

that the structures responsible for interpreting nerve signals as pain weren't developed until the last week or two of gestation.

However, the right to lifers don't care about the fetus. Punishing the woman in whose body it resides is what they're all about.

[vets74]

19. 26-weeks is accurate. This is a legal issue, not to be swept under a rug.

The pathway for pain to reach the brain does not develop until 26-weeks along.

Preemies differentiating pain and other stimuli at 35/37 weeks is a different topic altogether, which is irrelevant to what happens for a normal fetus at 20- or 26-weeks. Pro-Life claims about 20-weeks were invented from whole cloth -- effective politically nonetheless.

[RC]

2. This should generate some interesting responses from the fetus is supreme crowd.

Saw a bumper sticker today. "Unborn babies are people too. I wanted to change "Unborn babies" to "Women", but didn't have a marker.

[Warpy]

4. They'll ignore it just like they ignored the research it confirms.

[The Doctor.]

8. Because of you, I'm going to always carry a marker with me.

Thanks for that. It's a good thing.

[vets74]

20. Never underestimate your opponents. St. Ronnie, for example...

"With regard to the freedom of the individual for choice with regard to abortion, there's one individual who's not being considered at all. That's the one who is being aborted. And I've noticed that everybody that is for abortion has already been born."

-- Reagan during a presidential debate, September 1980

[xchrom]

5. Recommend

[Lost-in-FL]

6. "Suggests"

Nuff said.

[shraby]

7. It can only suggest because no one can talk or communicate

that early. If the reaction is the same to touch as to a pin prick that suggest the fetus is feeling them the same. If it draws away from a pin prick and not the touch, that shows that the pin prick is being felt and is painful.

[iverglas]

9. "Nuff said"

Unfortunately not. I have no clue what you are suggesting.

?

[iverglas]

10. for info

The findings also might explain why infants born prematurely have an abnormal pain response, the researchers said. "Clinical practice changed about two decades or more ago to take into account the pain response of premature infants and term infants," lead author Eliot Krane, professor of anesthesia and pediatrics at Stanford University School of Medicine, said in a statement. Krane added, "Clinical practice continues to evolve as we become more cognizant of the deleterious effect of pain in infants" (Conley, ABC News, 9/8).

What this is talking about is the fact that there is an hormonal response to pain stimuli at an earlier stage of gestation, but no "mental"/emotional response, based on perception of pain, until much later.

The practice that this affected was that of performing what would ordinarily be painful procedures on premature infants in the belief that they did not feel pain. Indeed, they do not perceive pain, but the physical response can be detrimental to development, and this resulted in the understanding that it is wise to minimize exposure to noxious stimuli even though the infants do not respond visibly to the pain stimulus.

[Crunchy Frog]

11. I'm pro-choice, but I think this is bullshit.

I'm speaking as the mother of preemies born at 33 weeks.

[PeaceNikki]

12. Why do you think this is bullshit?

If you read the Fabrizi study (primary source), what they're saying is that there is nonspecific brain activity associated with both pain stimuli and touch stimuli from 28 weeks onward but that this activity becomes different and specific for each type of stimulus only from about 35 weeks on. That is to say, the babies appear to develop the capacity to differentiate between painful stimuli and simple touch late in gestation; though there is brain activity that they perceive the stimuli earlier, that activity isn't different for different types of stimuli.

I understand that you have specific experience in seeing your babies react to stimuli outside of the womb at 33 weeks gestation, but this research monitored brain activity and was conducted in scientific (not emotional) terms. If someone has been born then they are NOT IN UTERO. A foetus cannot feel pain until weeks before birth due to the conditions in utero. Once someone has been born, and is no longer subject to the tranquilising conditions in the uterus, then they will react to stimuli but not necessarily pain as we would understand it because their nervous system is still underdeveloped. Once your babies were born, they were almost certainly reacting to stimuli and to being wholly unprepared for life in the outside world.

[Crunchy Frog]

13. I think it's BS, not only because of my personal experiences

but also because there is years worth of research in the area of neonatal and premature pain that contradicts the conclusions of this one single piece of research. For anyone with a baby in the NICU, pain control and monitoring the babies for pain is one of the top priorities for the nurses and the neos, in contrast to a couple of decades ago, when pain in the NICU was completely ignored.

Completely apart from my own experiences, this is one single study, whose results appear to be rather broadly interpreted, and whose results appear to contradict a large body of research going back decades. I would say that the results, and the interpretations of those results, are at least highly preliminary.

I know that people on DU get all excited about this sort of thing because they think it will give them ammo in the abortion debate. The truth is that fetuses in this gestational range are virtually never aborted. Also, the pro-lifers are as impervious to scientific evidence as the creationists are. The only thing that's likely to be affected by this new "data" would be the treatment of premature babies in the NICU.

I'm damned glad that my NICU considered pain control to be a priority, and glad that my one son who had to have a chest tube got morphine along with it. He still spent two full days crying inconsolably after he got rid of the chest tube and the vent and the morphine, but he stopped crying when I held him.

So rather than saying that I think this is BS, I will just say that I think this particular piece of research is highly preliminary, and its results and conclusions directly contradict a huge body of scientific resarch going back decades, and on which current medical practices with preterm neonates are based. I would need to see a HELL of alot more evidence than this single study, especially since it's largely being used to promote a particular political agenda.

[PeaceNikki]

14. I think you're misinterpreting the purpose of the study.

http://www.sciencedaily.com/releases/2011/09/110908124136.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29

http://www.sciencedaily.com/releases/2011/09/110908124138.htm


The results may have implications for the treatment, care, and development of premature newborns, Fabrizi said, noting that these children can often grow up to be either more or less sensitive to pain than usual.

"Repeated noxious stimulation of the kind used in this study is a feature of neonatal intensive care," the researchers wrote. "Our finding that noxious heel lance increases neuronal bursting activity in the brain from the earliest age raises the possibility that excess noxious input may disrupt the normal formation of cortical circuits, and that this is a mechanism underlying the long-term neurodevelopmental consequences and altered pain behavior in ex preterm children."

They are and were seeking how to best care for preemies. They are learning the immense benefits of Kangaroo Care and the importance of minimizing traumatic invasive events during this very crucial development time until the brain waves change. This study was not done with abortion in mind, but care of premature babies.

In the past two years, six states have banned abortion after 20 weeks on the grounds that that's when fetuses can feel pain. There is no reliable scientific evidence that this is true and this study seems to indicate otherwise as well.

My sister is a NICU RN and some of my closest friends are celebrating the 3 month birthday of their micro-preemie today. He was 1 lb 9 oz and he's coming up on 5 lbs now. I certainly understand the love, science, courage and strength of all parents and medical professionals in that department.

[iverglas]

15. exactly what I tried to point out in my "for info" post

Repeated noxious stimulation of the kind used in this study is a feature of neonatal intensive care," the researchers wrote. "Our finding that noxious heel lance increases neuronal bursting activity in the brain from the earliest age raises the possibility that excess noxious input may disrupt the normal formation of cortical circuits, and that this is a mechanism underlying the long-term neurodevelopmental consequences and altered pain behavior in ex preterm children.

Pain control in extremely premature babies is intended to avoid the physical/hormonal response to pain stimuli, not pain, i.e. the perception of pain.

The whole point is that where there is no perception of pain and therefore no visible/audible response to pain stimuli, there is still a physical/hormonal response to it that can be detrimental to the child's development.

The intent behind much of the research has been to determine whether pain stimuli should be avoided / treated with analgesics precisely because in the past it was thought that premature babies -- and even, earlier, full-term babies -- did not experience pain and therefore did not require analgesics, for instance.

The ones perverting the meaning of the research are really the anti-choice brigade, who pretend that findings relating to the physical response to pain stimuli, and recommendations that pain stimul be avoided/reduced/mitigated, means that the infants "feel" pain.

[vets74]

16. The title reverses the study. "Infants born at 28 to 35 weeks of development showed comparable...

... brain activity."

This is opposite to claiming that pain starts at 35 weeks. It would move pain to 28 weeks at latest, but actually says nothing about when pain starts.

The consensus scientific position puts this neonatal perception at 24 to 26 weeks. The establishment of thalamocortical connections (at about 26 weeks) is the critical development event that enables routing of pain impulses to the brain.

Prior to that development period the fetal nerve system is immature, as well, which could cause constant horrific pain to the fetus/unborn_child if the thalamocortical connection matured too early.

Abortion rights and issues of legal abortion are not well served for sensible discussion by such as this sloppy write-up of a scientific research article.

[iverglas]

17. I'm at a bit of a loss here

For a moment I thought you might have some sort of point; then I read the full sentence from which you had bizarrely excerpted that bit:

"Infants born at 28 to 35 weeks of development showed comparable...
... brain activity."

There is no period after the word "activity" in the passage you quoted from.

Let's look at the whole thing, with my emphasis:

Infants born at 28 to 35 weeks of development showed comparable brain activity for the touch and heel prick, but infants born at more than 35 weeks of gestation exhibited a greater response to the heel prick than the touch.

What's not to get here?

The entire point is that up to 35 weeks, the infants show comparable brain activity in response to very different things. (That is, the brain activity is comparable as between stimuli, not as between infants of different ages.)

The brain activity in response to a non-painful touch is comparable to the brain activity in response to a painful prick.

Only at 35 weeks do the infants react more strongly to the painful than to the non-painful stimulus.

You are the one who has completely reversed the meaning. How, when the meaning is so clear? Why?

[vets74]

18. Omaha Steve posted ::: "Fetuses First Perceive Pain at 35 to 37 Weeks, Study Suggests"

That is what reverses the cited study. That study is for preemies, not the usual 26-week fetuses.

I address development at 26 weeks as the thalamocortical connections come into play.

Btw: the 20-weeks limit by state governments is erroneous. They're playing to the grandstands.

[iverglas]

21. I'm sorry

but I really don't know what you're saying here.

That study is for preemies, not the usual 26-week fetuses.

What is a "usual" fetus? Why is a 26-week fetus a "usual fetus"? Does a study indicating that premature infants do not experience pain sensation at a certain state of development suggest that fetuses at the same stage of development do?

Your previous post said:

This is opposite to claiming that pain starts at 35 weeks. It would move pain to 28 weeks at latest, but actually says nothing about when pain starts.

This simply made no sense and was not what the study said. Nothing "moved pain to 28 weeks at latest". The study "moved pain to 35 weeks at the earliest", if anything.

You bolded this passage in your previous post:

The consensus scientific position puts this neonatal perception at 24 to 26 weeks. The establishment of thalamocortical connections (at about 26 weeks) is the critical development event that enables routing of pain impulses to the brain.

Is that quoted from somewhere or is that your words?

What is the point there? How does the stage at which a "critical development" that "enables" something occurs refute a finding that a certain response only occurs at a different point?

The abstract of the study says:

http://www.cell.com/current-biology/abstract/S0960-9822%2811%2900885-2?script=true

A Shift in Sensory Processing that Enables the Developing Human Brain to Discriminate Touch from Pain

... We show a transition in brain response following tactile and noxious stimulation from nonspecific, evenly dispersed neuronal bursts to modality-specific, localized, evoked potentials. The results suggest that specific neural circuits necessary for discrimination between touch and nociception emerge from 35–37 weeks gestation in the human brain.

There really isn't anything ambiguous about that and I really still don't know what point you are making.

You say:

I address development at 26 weeks as the thalamocortical connections come into play.

I'm sorry, but: ... yes? ... so?

No one seems to be having any trouble interpreting the published results:

http://www.sciencedaily.com/releases/2011/09/110908124136.htm

... In the premature babies the EEG recorded a response to the heel lance of non-specific 'neuronal bursts' -- general bursts of electrical activity in the brain. After 35-37 weeks the babies' response changed to localised activity in specific areas of the brain, indicating that they were now perceiving painful stimulation as separate to touch.

Dr Lorenzo Fabrizi, lead author of the paper from UCL Neuroscience, Physiology and Pharmacology, said: "We are asking a fundamental question about human development in this study -- when do babies start to distinguish between sensations? In very young brains all stimulations are followed by 'bursts' of activity, but at a critical time in development babies start to respond with activity specific to the type of stimulation."

Dr Fabrizi added: "Of course, babies cannot tell us how they feel, so it is impossible to know what babies actually experience. We cannot say that before this change in brain activity they don't feel pain."

Previous studies have shown that there is a similar shift from neuronal bursts to evoked potentials in the visual system at this time, suggesting that 35-37 weeks is a time when important neural connections are formed between different parts of the brain. ...

And here is some relevance to reproductive rights:

http://www.emaxhealth.com/8782/unborn-child-pain-awareness-act-unaware-pain-discrimination-begins-week-35

According to scientists, recent results show that the human brain may first begin to discriminate touch from pain during weeks 35 37 of gestation in the human fetus. However, anti-abortion activists have contended that a fetus can feel pain as early as week 20 of gestation. Bills by like-minded legislators have been and still are under consideration by Congress to attempt to put into law the stipulation that before receiving an abortion, a woman must be advised that an abortion procedure will cause pain to her fetus. This bill is currently under the title “Unborn Child Pain Awareness Act of 2011.”

... According to a press release from the office of Senator Johanns when he introduced the bill to Congress last year, “Medical research has taken a quantum leap forward in recognizing that unborn children feel pain. It is time to acknowledge this reality in law and in practice,” said Johanns. “This is not a pro-life or pro-abortion issue; it is an issue of human compassion. My legislation simply says mothers have a right to be informed and to show compassion by requesting pain medicine for their babies if they do not choose life. States are leading the way by passing similar legislation and we, as a civilized nation, should do the same.”

Women have a right not to be lied to by their governments in an effort to interfere in their exercise of their rights, actually.

You say:

Btw: the 20-weeks limit by state governments is erroneous. They're playing to the grandstands.

and so if 20 weeks is erroneous, what is not?

The answer, if we are talking about a limit on access to abortion based on fetal pain perception, is 35 weeks, right?

[vets74]

22. 1. Review the anatomy & phsyiology of the thalamocortical connections.

2. Review prenatal development for these structures.

The A&P will explain what TCCs do. Since they mature for the normal/typical fetus at 26-weeks, pain signals will not reach the brain until that point of development.

Arguments about TCC-dependent functions at 35-weeks are irrelevant to what happens up till 26 weeks.

Also, at 20-weeks there are no mature TCCs. Arguing about pain for a 20-week fetus ? That is not based in known A&P science.

[iverglas]

23. okay, I give up

Since they mature for the normal/typical fetus at 26-weeks, pain signals will not reach the brain until that point of development.

Nobody here is arguing that point.

The point of the article, based on the results of the study, was that pain perception does not occur until circa 35 weeks. Pain signals and pain perception are not the same thing.

Forgive me, but I simply do not know what you were or are taking issue with here.