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

N. J. van den Hoogen*, J. Patijn, D. Tibboel, E. A. Joosten

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

11 Citations (Web of Science)

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.

Original languageEnglish
Pages (from-to)5902-5910
Number of pages9
JournalCurrent Pharmaceutical Design
Volume23
Issue number38
DOIs
Publication statusPublished - 2017

Keywords

  • Neonatal pain
  • NICU
  • repetitive pain
  • long-term effects
  • plasticity
  • analgesic drugs
  • RAT SPINAL-CORD
  • LONG-TERM CONSEQUENCES
  • DECREASED SUBSTANCE-P
  • INTRAVENOUS PARACETAMOL
  • DORSAL-HORN
  • LATER LIFE
  • RECEPTOR IMMUNOREACTIVITY
  • POSTNATAL-DEVELOPMENT
  • MORPHINE EXPOSURE
  • BRAIN-DEVELOPMENT

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