The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149726/1/pan13639_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149726/2/pan13639.pd

The meaning of pain expressions and pain communication

Both patients and clinicians frequently report problems around communicating and assessing pain. Patients express dissatisfaction with their doctors and doctors often find exchanges with chronic pain patients difficult and frustrating. This chapter thus asks how we could improve pain communication and thereby enhance outcomes for chronic pain patients. We argue that improving matters will require a better appreciation of the complex meaning of pain terms and of the variability and flexibility in how individuals think about pain. We start by examining the various accounts of the meaning of pain terms that have been suggested within philosophy and suggest that, while each of the accounts captures something important about our use of pain terms, none is completely satisfactory. We propose that pain terms should be viewed as communicating complex meanings, which may change across different communicative contexts, and this in turn suggests that we should view our ordinary thought about pain as similarly complex. We then sketch what a view taking seriously this variability in meaning and thought might look like, which we call the “polyeidic” view. According to this view, individuals tacitly occupy divergent stances across a range of different dimensions of pain, with one agent, for instance, thinking of pain in a much more “bodycentric” kind of way, while another thinks of pain in a much more "mindcentric” way. The polyeidic view attempts to expand the multidimensionality recognised in, e.g., biopsychosocial models in two directions: first, it holds that the standard triumvirate— dividing sensory/cognitive/affective factors— needs to be enriched in order to capture important distinctions within the social and psychological dimensions. Second, the polyeidic view attempts to explain (at least in part) why modulation of experience by these social and psychological factors is possible in the first place. It does so by arguing that because the folk concept of pain is complex, different weightings of the different parts of the concept can modulate pain experience in a variety of ways. Finally, we argue that adopting a polyeidic approach to the meaning of pain would have a range of measurable clinical outcomes

Development of a System for the Assessment of Heart Rate Variability in the NICU

Heart rate variability (HRV) analysis is used to examine morbidity and mortality in premature neonates. We developed a system to acquire and analyze full frequency spectrum HRV based on ECG signal to identify frequency ranges associated with responses to "normal care" of the NICU neonate. The system will allow real-time monitoring of specific frequency ranges at the bedside. Twenty NICU newborns were enrolled under University of Miami IRB approved protocol. Infants were recorded before, during and after procedures associated with normal NICU care. ECG signals were sampled from analog output from a standard bedside monitor using a custom interface based in an Arduino system. Interface was connected to a computer running a LabView program for real-time process. Pam-Tompkins QRS detection algorithm was tuned to spectral characteristics of the preterm ECG signal; HRV computation was done using the Lomb-Scargle algorithm. ECG acquisition was safe, reliable and appropriate for HRV computation. 1186 minutes of ECG were sampled at 1000SPS and processed. The QRS detection algorithm was reliable, requiring minor intervention to eliminate artifacts. HRV computation using non-uniformly spaced samples was appropriate for ECG analysis. HRV can be used in real time to monitor neonatal response to normal care

Neonatal Pain Facial Expression: Evaluating The Primal Face Of Pain

The primal face of pain (PFP) is postulated to be a common and universal facial expression to pain, hardwired and present at birth. We evaluated its presence by applying a computer-based methodology consisting of point-pair comparisons captured from video to measure facial movement in the pain expression by way of change across two images: one image before and one image after a painful stimulus (heel-stick). Similarity of facial expression was analyzed in a sample of 57 neonates representing both sexes and 3 ethnic backgrounds (African American, Caucasian and Hispanic/Latino) while controlling for these extraneous and potentially modulating factors: feeding type (bottle, breast, or both), behavioral state (awake or asleep), and use of epidural and/or other perinatal anesthesia. The PFP is consistent with previous reports of expression of pain in neonates and is characterized by opening of the mouth, drawing in of the brows, and closing of the eyes. Although facial expression was not identical across or among groups, our analyses showed no particular clustering or unique display by sex, or ethnicity. The clinical significance of this commonality of pain display, and of the origin of its potential individual variation begs further evaluation. © 2008 International Association for the Study of Pain