Thursday, February 17, 2011

Chronic pain & infant circumcision

 The circumcision experience is at the very least an excrutiatingly painful one. Research evidence found that circumcised babies had much greater pain response at 6 months immunizations than their intact peers. The theory and evidence for neural plasticity grows daily. Basically Neural Plasticity tells us the brain changes with experience. The brain has changed with experience of circumcision, some neural pruning would have occurred, and some neural pathways developed. I believe at the very least we have basically changed the way a circumcised male will experience pain throughout his life. Exactly how its changed the experience of pain would be unknown, but at least we know that at 6 months pain is experienced more severely. So yes circumcision causes change to the brain as well as the penis, it requires further study, but cant see the AAP funding this in a hurry!!!

The study below found infant circumcision pain was still affecting circumcised babies 6 months after their circumcision, and no follow up studies have ever been done to determine whether pain response kept going throughout life??????

 

THE LANCET (London), Volume 345, Number 8945: Pages 291-292,
4 February 1995.




Effect of neonatal circumcision on pain
responses during vaccination in boys

Anna Taddio, Morton Goldbach, Moshe Ipp,
Bonnie Stevens, Gideon Koren


Using data from one of our randomised trials, we investigated post-hoc whether male neonatal circumcision is associated with a greater pain response to routine vaccination at 4 or 6 months. Pain response during routine vaccination with diphtheria-pertussis-tetanus (DPT) alone or DPT followed by Haemophilus influenzae type b conjugate was scored blind. 42 boys received DPT and 18 also received HIB. After DPT, median visual analogue scores by an observer were higher in the circumcised group (40) vs 26 mm, p=0.02) After HIB, circumcised infants had higher behavior pain scores. (8 vs 6, p=0.01) and cried longer 53 vs 19 s, p=0.020. Thus neonatal circumcision may affect pain response several months after the event.
Lancet 1995; 344:291-92


Neonatal Cortisol Response to Circumcision with Anesthesia

  1. Paul S. Williamson
    1. Department of Family Practice, The University of Iowa College of Medicine, Iowa City, Iowa
  1. Nolan Donovan Evans
    1. Department of Family Practice, The University of Iowa College of Medicine, Iowa City, Iowa

Abstract

Eleven male newborns were circumcised with a local dorsal penile nerve block, and 13 controls were circumcised without anesthetic. Matched pairs of pre- and postcircumcision cortisol levels in the two groups were compared. The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine. Blood sampling and anesthetic injection of venipuncture alone did not evoke the adrenal response in uncircumcised control infants. Cortical input or secondary epinephrine elevation may be producing the cortisol elevation in infants despite regional blockage of the afferent nerve pathways.

No comments:

Post a Comment