JAMA study: Fetuses under 7 months may not feel pain

[BurtWorm]

Could throw a monkey wrench in winger plans to force abortion providers to anaesthetize fetuses. :think:



Fetuses May Not Feel Pain in Early Months
By THE ASSOCIATED PRESS
Filed at 4:00 p.m. ET


http://www.nytimes.com/aponline/national/AP-Fetal-Pain.html

While brain structures involved in feeling pain begin forming much earlier, research indicates they likely do not function until the pregnancy's final stages, said the report's senior author, UCSF obstetric anesthesiologist Dr. Mark Rosen.

Based on the evidence, discussions of fetal pain for abortions performed before the end of the second trimester should not be mandatory, the researchers said.

The authors include the administrator of a UCSF abortion clinic, but the researchers dispute the claim that the report is biased.

Dr. Catherine DeAngelis, JAMA's editor-in-chief, said the decision to publish the review was not politically motivated.

''Oh, please,'' DeAngelis said. ''If I had a political agenda, I wouldn't pick fetal pain.''

[gratuitous]

1. Dr. Frist says

Their little eyes are tracking the balloon!

But what do JAMA researchers know, anyway? Oh sure, they get their papers and their findings published, but how does that compare to the "rock-solid feeling" other doctors have?

For our friends lurking from other sites, let me say this is how research works. Now, either the review is supported by scientific evidence or it isn't. The Journal of the American Medical Association, however, is a peer-reviewed journal, which means that the paper in question was read and reviewed by other researchers who have no interest in the paper, its publication, or whatever follows from it. They looked at the research, the methodology, the qualifications of the people who did the study, and they passed on the paper, meaning that it holds up to their scrutiny.

If other researchers have a beef with the paper, it's up to them to conduct their own study, with a full accounting of their methods and the researchers' qualifications. That's how the scientific method works. Merely quoting a passage from Jeremiah doesn't qualify as research.

That about explain it?

[Beetwasher]

2. Are You NUTS! That's SCIENCE!!! It's EVIL!!!! God Told Me They Feel Pain!

Who you gonna believe? God or some evil guy in a labcoat who kills babies for a living? :sarcasm:

[SoCalDem]

5. and.. That's NOT amniotic fluid.. It's TEARS...

from the PAIN of worrying about bein' aborted :sarcasm:

[On the Road]

3. Since Roe v Wade Protections Don't Apply Past the 6th Month

during the time the fetus can feel pain, abortion is pretty much off the table anyway.

On the other hand, during the first trimester, it difficult (or should be difficult) to argue that the fetus should have legal standing as a human being. They just aren't sufficiently developed.

I think the whole abortion issue boils down to the biological status of the fetus during the second trimester. And this JAMA study is another piece of the scientific case that Roe v Wade was a sound decision.

[Mairead]

4. I'm very suspicious of this. They used to say non-humans don't feel pain

They even used to say that Black folk didn't feel as much pain as Whites!

I'm very suspicious.

[BurtWorm]

6. They say they "MAY" not feel pain.

That's the difference between scientists and ideologues of any stripe.

I suspect the solution to the problem will lie in a study of the mechanisms of pain and how developed the embryo's version of that mechanism is at various stages.

Does a cell or a blastocyte feel pain? Wouldn't it take a fairly well developed nervous system to feel pain? At some point, the fetus must take a quantum leap toward sensitivity, though.

[Mairead]

11. "At some point, the fetus must take a quantum leap toward sensitivity"

I wonder. Why wouldn't it be a gradual process, one of increasing organisation like the rest of pre- and neo-natal development?

[BurtWorm]

15. At one point, there's not enough development of the pathways

and at the next moment, there is. At one moment the center of the brain that processes pain is not sufficiently developed, and the next moment it is. Doesn't it seem like it's an off/on situation? I don't know for a fact if my surmise is right, but I do know that early development of an embryo is full of off/on moments.

[sepia_steel]

23. There must be some chemical test to determine when...

that's how you know what your baby will be - liberal or conservative?

Conservative babies never make that transition. :P

[SoCalDem]

7. They also said that infants don't feel pain "like adults do"

I watched our 2 yr old break out into a cold sweat and tremble, because he was in so much post-op pain..Had to practically BEG the doctor to give him painkillers..

[Mairead]

12. "Had to practically BEG the doctor to give him painkillers"

I can imagine, poor wee thing.

I've met a number of docs who never should have gone into clinical practice. Pathology, okay. Microbiology research, maybe. But not dealing with live animals that can feel pain and fear.

[Horse with no Name]

20. That's horrible

There are infant pain scales available "FLACC" for instance (with non-verbal clues regarding pain), and it is widely accepted that infants and young children do feel pain and that is an issue that has been widely addressed in the past few years--at least in major medical centers.
I'm sorry you had to experience this.

[SoCalDem]

24. This was MANY years ago.. He's now 31

but he had 28 operations before he was 8..the first one at 3 weeks (he didn't even weigh 5 lbs)..

Don't know how we all survived those years:)

[Mairead]

27. My god! 28 ops before he was 8? That poor creature.

Was it an orthopaedic thing? (if I'm being too nosy, ignore me)

[SoCalDem]

30. Nope..He was born with

extrophy of the bladder..and his surgeries are probably featured in textbooks..Most of his surgeries were experimental, since there are many variations of the anomaly, and no "real" way to correct it fully.. 26 of the surgeries were at Mayo Clinic-StMarys Hospital.. I could probably still draw a mental map of rochester Minnesota..

A million years ago..and still like yesterday..

He just found out that he has a "staghorn" kidney stone and has to have surgery next month.. He's ok with it, but his wife is a bit scared..

[Pirate Smile]

25. My mother tells horror stories of when my sister and I were little and

had accidents requiring trips to the emergency room or the doctor. They were digging fingernail fragments out of my nail bed without anesthesia and telling her I couldn't feel it or it didn't hurt me while I screamed. She was livid. (this would be late 60's - early 70's)

They also were giving my sister stitches in her head and said "she can't feel it". My pissed off Mom said "well then why is she screaming every time you stick her with the needle".

I can't believe doctors could have actually believed that crap.

I had the same problem with my son's circumcision - he is 6 years old now. "He can't feel it". What load of crap. I believe they have now started to use more anesthesia. They kept saying the complications from the anesthesia would be worse then the pain, blah, blah. I wanted to tell the Dr to drop his draws and let's go after his you know what with a knife and say he can't feel it.

I swear they used to think kids could only feel pain if they could verbally state "that hurts".

Fetuses - I don't know because I don't know at what age certain areas develop. I had a baby born at 34 1/2 weeks (5 weeks premature)and she couldn't breastfeed because she hadn't developed the "suck, swallow, breath" reflex.

[Beetwasher]

8. Uhh, Except there Was No Empirical Evidence To Back That Up

This isn't some nebulous "they" saying anything. This is a scientific study that was carefully prepared and carried out. They didn't go into it w/ any preconceived notions, they came to a conclusion based upon where the evidence lead them. It's perfectly plausible that when the brain is NOT TOTALLY DEVELOPED, it doesn't function completely.

Quite frankly, I find your comparison of these scientists to racist scumbags to be incredibly ignorant.

[Mairead]

9. Before you shoot off your mouth another time, you might like to look

up the history: the 'they' I spoke of were credentialed scientists of the day.

[Beetwasher]

10. Bullshit

How about a link to back that up.

[Mairead]

13. Do your own research -- it's hardly esoterica. You should have learned it

in Psych 101.

[Beetwasher]

14. So You Make A Bullshit Claim and Fail To Back It Up

Figures. No surprise there.

[Book Lover]

16. I would be very interested in reading

anything you could find to support your claim.

[Mairead]

19. Do a search on 'race' as a determinant in treatment of pain

Then:

"It was widely believed in the 19th century that racial groups varied in their physiological experiences to pain, with women, whites, and the rich being more sensitive to pain than African Americans, criminals, and Native Americans, who were seen as "virtually impervious to physical trauma." Indeed, a medical term was coined, "dysaesthesia Aethiopsis" or "an obtuse sensibility of body," to describe the genetic insensitivity to pain attributed to those of African descent."

Clark EB. J Am History 1995; 82(2):463-493., cited at http://www.iasp-pain.org/PCU02-5.html

Now:

"The most recent study published as of June 30,2000 on race and ethnicity as variables in pain treatment is a January 2000 study published by Todd, Deaton, D'Adamo, and Goe, titled "Ethnicity and Analgesic Practice," in the Annals of Emergency Medicine.41

The objective of this study was to determine whether black patients with extremity fractures were less likely to receive emergency department analgesics than similarly injured white patients. The study builds on Todd's 1993 study of Hispanics at the Southern California Academic Center in the city of Los Angeles.42

The study was a retrospective cohort study at an urban emergency department in Atlanta, Georgia. Emergency department records were reviewed for a forty-month period (September 1, 1992 through December 31, 1995) to identify all black and white patients discharged from the emergency department with a diagnosis of isolated long bone fracture.43 The study consisted of 217 patients, of whom 127 were black and 90 were white. The study found that the white patients were significantly more likely than black patients to receive analgesics (74 percent versus 57 percent, p = 0. 01) despite similar records of pain complaints in the medical record.

The risk of receiving no analgesic while in the emergency department was 66 percent greater for black patients than for white patients."

K.H. Todd et al., "Ethnicity and Analgesic Practice," Annals of Emergency Medicine, 35 (2000): 11-16. cited at http://www.doctordeluca.com/Library/WOD/RaceEthnicityPain01.htm

[Beetwasher]

28. So, Your Comparing This Research To The Ignorant Racists of the 19th Cent.

You wrote;

"They even used to say that Black folk didn't feel as much pain as Whites!"

And:

"...the 'they' I spoke of were credentialed scientists of the day."

From the first article you posted:

"It was widely believed in the 19th century that racial groups varied in their physiological experiences to pain...25

Widely believed is NOT necessarily the "credentialed scientists of the day" (whatever that's supposed to mean). It was also "widely believed" that people could be possessed by demons. And, as a matter of fact, there's also this that you failed to mention: "Abolitionists’ narratives about the pain and cruelty suffered by slaves played an important role in extending the broad culture of individual rights that ultimately included the right to health and health care, and most recently, pain care."

So, IOW, some racist assholes in the 19th century, that probably did include some in the medical profession (so what? There's racist assholes everywhere, especially in the 19th cent. and that certainly doesn't mean they were "credentialed scientists", whatever that means), were promulgating the lie that blacks don't feel pain. Others thought differently.

And "they" (the racist assholes) were proven wrong anyway, through empirically valid studies. "They" didn't have empirically valid studies to back up their bullshit.

To compare these scientists today, who have their study published in one of the most respected medical journals in the world, to the racism and ignorance of the 19th century is ignorant nonsense and the mark of someone who is merely trying to tar their research because of a bias against the findings.

The second article you posted is completely irrelevant. It has to do w/ treatment in emergency rooms and the inequality of treatment. It has nothing to do w/ anyone claiming blacks don't feel pain the same way.

"The risk of receiving no analgesic while in the emergency department was 66 percent greater for black patients than for white patients."

That's racist, but it has nothing to do w/ this research.

[msmcghee]

17. You make an interesting comment.

Antonio Damassio, a leading brain science researcher, in "The Feeling of What Happens" separates emotion and feeling as two distinct concepts that I believe are useful to this discussion:

Emotion - the body's response to its environment. Like a quickening of the heart and sweating of the palms when we are in danger.

Feeling - Our awareness of the sensation of our emotional state, such as the sensation that we feel afraid.

I'm sure that even embryos have what can be called rudimentary emotional responses. But feelings are only useful for making choices. Choices in humans require reasoning, weighing of alternatives.

We make all such choices in an effort to enhance our feelings. Feeling better is the force that drives our decision process - in an effort to feel better than otherwise as a result. Feelings also provide the markers that allow us to remember strongly emotional events - so we can make a better decision next time we encounter it. So feelings are useful for reasoning, remembering and making choices.

What possible choices could an embryo have to make? It has no choices to make. Whatever responses it has, like kicking or adjusting it's position, can easily be handled by a developing emotional system with automatic muscle activity.

Human babies, because of their large brain case are born very early compared to all other mammals. It seems to me that the behavior of even well-developed mammals at birth, such as antelope that must be able to stand within minutes, is pretty much limited to instinctive acts. Even during an antelope's life very little reasoning ever occurs, hence very little need for an antelope to ever "feel" very much.

So, it seems very unlikely to me that even the most rudimentary feelings, as described by Damassio, would be necessary in human babies until weeks after birth. Evolution does not squander. It does not provide abilities that are not needed - as that would be a waste of developmental energy that could be better spent elsewhere in the process.

Or, for an embryo or newborn to feel, it would need to be able to make choices. I doubt that happens and I doubt that feelings as such, are present in embryos and newborns until they are needed - to begin learning to make rudimentary choices.


As evidence, I think this is why babies don't remember their birth and also why no boy babies remember their circumcision. The feeling mechanism that allows us to be aware of our emotional state is not yet in place - because it is not yet needed.

[Raiden]

33. That's interesting stuff

[msmcghee]

18. There's also the process of mylenation whereby . .

. . the neurons that carry electrical messages through our bodies develop an insulated coating. Until this is complete at about 7 months of age, those signals have no specific pathways yet, they all cross over and interefere with each other. A newborn therefore can not organize their thinking activity enough to be actually aware of any specific events - as an older baby or toddler would.

That's why a baby will have a startle reaction that activates all its muscles at once - from a loud noise for example. They don't yet have the ability to separate things in their mind - either the input or the output. Since feelings are discrete sensations - it seems unlikely that they could have those in any coherent sense as well.

[bleedingheart]

21. I am still a bit like that...

which is why my hubby calls me a spaz...

[Mairead]

22. Are you talking about the self-awareness component in the perception

of pain? I'm not really sure I'm following you.

[msmcghee]

26. Yes, consciousness . .

That's the area that I find most confusing too. But then the question of consciousness is the holy grail of brain science. The puzzle that has yet to be solved.

However, I think he lays a good foundation for the notion that emotions (automatic body responses) are exhibited by all mammals and must be present fairly early in development. The brain does not need to be aware of emotions.

Feelings are awareness of body state. Their function is to provide the impetus for logical decision-making - and markers for learning. This is highly developed in adult humans (and also in some higher mammals like dogs or whales and other primates). I suspect the ability to have feelings develops concurrently with our ability to use them to make those decisions. (It seems unlikely that we would have evolved the ability to have feelings at some early stage of life without also the ability to make decisions that could affect those feelings.)

I guess I am saying that feelings are only available to decision-making creatures and generally only as they develop the reasoning ability to make such decisions.

(Don't blame all this on Damassio as I'm sure I have taken liberties here.)

[BurtWorm]

29. Here's an interesting article on a study in what causes pain

http://www.thenakedscientists.com/HTML/Columnists/petermcnaughtoncolumn1.htm

In fact pain is really very poorly understood, in spite of years of study. We do not even know very much about how nerve fibres detect pain. Do the nerve endings react directly to pain, or is it that damage releases something from other cells, which then stimulates the nerve fibres? And how can pain be so variable? Is this something happening "in the mind" or are there processes happening out at the periphery, at the level of the nerve terminals, which might explain the variability of pain?

These are the questions that my lab in Cambridge is trying to answer. We abandoned the idea of studying pain in intact animals and went instead for the simpler situation of isolated nerve cells cultured in a dish. We have found that they respond in many ways like pain-sensitive nerves in a real animal. For instance, we found that the temperature at which these isolated pain-sensitive nerves respond to heat is very similar to the temperature at which a human subject reports that the sensation from a warmed object changes from a pleasant feeling of warmth to a sensation of painful heat. We found out something about the way in which heat actually stimulates the nerve endings - it is a direct process, caused by sodium ions flowing in through the membrane of the cell. So the actual response to heat is intrinsic to the nerve fibre itself, and does need any factors which might be released from nearby cells damaged by the hot stimulus.

But the isolated nerve fibres did differ in an interesting way from their counterparts in an intact animal. If a hot stimulus is repeatedly applied to skin the sensation of pain gets worse and worse, as we all know, while our isolated nerves in culture always responded with a signal of the same size. This told us that the process of sensitization, by which the feeling of pain increases with time, is not intrinsic to the nerve fibres, but instead depends on factors released from other nearby cells which in an intact animal are damaged by the painful stimulus. Nearby cells are, of course, not present in a culture of isolated nerve cells. We identified one of these factors as a protein fragment called bradykinin, which was already known to be present in elevated concentrations in damaged or inflamed tissue.

So, in summary, transduction, or the process by which a nerve cell detects pain, is quite separate from sensitization, the process by which pain gets worse with time. The first is present in a nerve fibre by itself, and does not need any other partners in order to produce a normal response to heat. The second needs bradykinin, and probably other factors as well, to be released from damaged cells nearby in order to occur. We have now found out quite a lot about what is happening at a molecular level inside the nerve during both of these processes. All this atttracted considerable media attention, and the work was featured in several national newspapers, in the popular science magazine "New Scientist" and on BBC television.

[msmcghee]

31. If I understand . .

. . this would imply that all creatures with nerve cells have the ability to feel pain - an emotion, an automatic response of the body to a stimulus. I agree.

This would still allow the further differentiation of the feeling of being in pain, our awareness of the pain - from the emotion. As per Damassio.

Perhaps this is why animals can be trained by repeating an exposure to a stimulus - conditioning.

And why humans can go beyond conditioning to use reason to predict the logical likelihood of feeling pain as the result of a decision.

It is possibly because we are able to use the feelings of past experiences, the memory of the "feeling" the pain, a conscious act, to more logically sort those experiences to predict what factors are involved and more cleverly avoid it in the future - rather than simply becoming conditioned to a stimulus.

I suspect this "consciousness" is what makes us different from most other animals. It also says that "feelings" and "consciousness" are part of the same survival process. Interesting stuff.

BTW - I'm not advocating for any particular POV here. Just enjoying the discussion.

[BurtWorm]

32. If I understand the article, it isn't nerve cells alone

but the presence of certain proteins--neurotransmitters?--that makes pain intelligible.

[txaslftist]

34. Gonna go and start one of these up again, huh? hot in here.