Neurophysiologische Grundlagen der Schmerzwahrnehmung bei Feten, Neugeborenen und Säuglingen

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    • Neurophysiologische Grundlagen der Schmerzwahrnehmung bei Feten, Neugeborenen und Säuglingen

      H.-J. Droste

      Even up to a few years ago, it was assumed that neonates were incapable of specific pain perception because the nervous system was not fully developed. For this reason, adequate anaesthetic procedures and satisfactory postoperative anaesthesia were frequently neglected. New research results have led to a thorough revision of these ideas that had been handed down through the ages on pain perception in infants. The basis for pain perception could even be present during fetal life.
      We now have to assume that around the time of birth the biochemical functional processes of peripheral nociception stimulus by mediators and the development of the cutaneous nociceptors and the spinal posterior horn system are already largely complete. Incomplete myelinization of peripheral nerves and spinal cord tracts also provides no compelling argument against pain perception by neonates; for one thing, a large part of the peripheral nociception conduction takes place by way of nonmyelinized C-fibres anyway, in addition to which the development of myelinization is faster than formerly assumed and incomplete myelinization means only that impulse conduction is slower, and not that it does not take place at all. Under the premise of Melzack’s and Wall’s gate control theory, a reduced flow of stimuli from mechanoreceptors over myelinized fibres to the posterior horn could even reinforce the conduction of nociceptive impulses in some circumstances.
      In the sector of descending antinociceptive pain control the development is rather slower in comparison.
      Zwischentöne sind Krampf
      im Anti-Verstümmelungskampf