Just like adults and older children, premature babies can feel pain. In the past, it was argued that premature babies lacked the ability to feel pain. It was believed their nervous systems were not yet developed enough. Now we know this is not true. In addition to being able to feel pain, premature babies also have the right to pain relief. Every reasonable effort should be made to keep premature babies pain free.
What is pain?
Most commonly, pain results when we are exposed to situations that are likely to lead to injury or tissue damage. In this respect, pain is a useful occurrence and a vital mechanism by which we protect ourselves from possible further damage and aid the healing process. Reflexively flinching from a hot kettle is an example of this function.
At the same time, pain is different for everyone and is always experienced within an individual emotional, intellectual, and situational context. For example, a child might scrape their knee and feel no pain until the injury has been pointed out to them. The amount of pain a child feels can also be changed by the way in which parents and others respond to the situation. A parent who over-dramatizes a child’s minor injury may increase the amount of pain felt by the child. In addition to children generally taking emotional cues from those around them, it is understood that fear and anxiety play a large role in modulating the pain experience.
Compared to older children and adults, a premature baby’s context for feeling pain is not as developed. However, premature babies do feel pain and feel it within their own emotional and situational context.
Pain is in the brain
When we hurt ourselves, we usually feel pain. If we touch a hot object we feel a burning pain in our hand, but it is our brain that is creating the perception of pain. The brain cannot detect pain directly. It relies upon a sophisticated system of nerves and receptors in the skin, muscles, joints, and organs, and their connections to the spinal cord and brain. When we touch the hot object, the brain is able to detect that damage is occurring, locate where it is occurring, and tell the body how to respond. To us it feels as if our hand is burning, but this feeling is created within our brain from the information it receives.
Conflicting messages
While pain messages go back and forth between the body and the brain, so do many other types of messages. This is important in terms of pain relief because pain messages and other types of messages actually compete in a way with each other. This is why if you hurt your knee, rubbing it may help relieve the pain. The soothing messages created by the rubbing compete with the pain messages created by the injured knee. In the case of a premature baby, soothing sensations may help alleviate pain in the same way.
Pain categorized by duration
The most common way that child and adult pain is categorized is in terms of time: essentially, how long the pain lasts and how quickly it disappears. Using this classification, there are two general types of pain. Acute pain is short-term and chronic pain is long-term, lasting at least three months without interruption. We do not know how long pain must be endured by babies to be considered chronic.
These pain types are not mutually exclusive. Both acute and chronic pain can be felt at the same time. Nor are these pain types rigid: for example, acute pain, especially if not properly addressed and treated, can become chronic pain.
Mind and body
While it is true that our understanding of pain and how it is felt has improved over the decades, there is still plenty to learn about what pain is, how it is felt and what can be done to relieve it. Given that pain is both a mind and body experience, it is probably best to think of pain in both emotional and physical terms at the same time. Especially when trying to assess and relieve pain, it is probably best not to think of the actual physical injury alone.
What causes pain in premature babies?
Premature babies may experience pain because they are sick or injured in some way or from painful procedures, both diagnostic and therapeutic. So-called procedural pain might include needles for blood sampling. From a clinical point of view, procedural pain has an advantage: healthcare providers know in advance that pain is going to occur. This allows pain relief measures to be taken before the painful procedure.
Caregivers in the NICU will attempt to minimize pain, whether it is a result of some form of injury or of a procedure.