"My research is centered on trying to find ways of alleviating infant pain safely" says Dr. Johnston. Her major focus is on pain in preterm infants. Premature babies may feel more pain than other infants because their coping mechanism is still at immature stage. Dr. Johnston’s little patients are not fully developed and often remain in the Intensive Care Unit for extended periods of time. "If you think about it, [preterm infants] are meant to be in the protective environment of the womb at that age and they’re in this loud, noisy, really hostile environment." These developmentally immature babies often become hypersensitive to pain. Sticking a baby’s heel to draw blood can be a very painful procedure for that child.
Dr. Johnston and her team are looking at various ways of diminishing pain in preterm babies. They found, for example, that skin-to-skin contact between premature babies and their mothers can reduce the discomfort caused by painful procedures. This "kangaroo care," seems to promote a sense of security in the babies. "Preterm infants are comfortable in this position... and by promoting a quiet state and physiological stability, we’re hoping that the impact of a painful event, such as a heel stick, will be dampened."
Music, in the form of lullabies sung by the mothers, may also help soothe babies’ pain, Dr. Johnston points out. "Mothers have been using what we call ordinary, everyday comforting mechanisms for millennia, and we’re just now trying to take those mechanisms that mothers use intuitively with babies and move them into the intensive care setting." We may even learn something from animals about controlling pain in babies, says Dr. Johnston. She’s studying mother rats to see how they comfort their pups when they experience pain.
Dr. Johnston has also been looking at the effects of giving infants sugar during invasive Intensive Care Unit procedures (like the heel stick). The sugar may cause the release of pain suppressing endorphins. "Sweet-tasting substances seem to have an analgesic effect in newborns and premature infants, and we think that happens through the release of endorphins."
Surprisingly, this effect is dose dependent. Dr. Johnston and her team have found that giving more doses of sugar over a whole week in very premature infants may have some negative impact on development when the baby is at term age. Obviously more research is needed in this area.
Hush Little Baby
Source: Gaia Remerowski, gremer@po-box.mcgill.ca
Along with her research on preterm infants, Dr. Johnston also coaches pediatric nurses in ways of dealing with infant pain. "It’s very difficult to tell if an infant is in pain and the degree of discomfort the child may be experiencing," she says. Certain signs, however, can give clues about what infants are feeling. Facial activity and cry analysis may help physicians and nurses determine the extent to which a baby is suffering.
On top of all her research, Dr. Johnston still finds time to head up an extensive pain awareness campaign as Director of the Canadian Pain Society. This initiative involves sending out information packets about pain treatment options to physicians, nurses and patients in a number of clinics and hospitals. "Essentially the message is that you have a right to have your pain treated and the staff caring for you have an obligation to treat your pain."
So after all this, do we know what parents should do when their babies start to cry? Not exactly. But Dr. Johnston points out that a lot of the things that parents do intuitively actually do work. "I think rocking, swaddling, giving pacifiers, playing soothing music or singing songs all help. What you’re trying to do is move the attention from the pain or the discomfort to something else." "There’s no magic," she adds, "tender loving care may buffer the effects of pain. Parents, doctors and nurses should not dismiss that."
This is the third in a series of interviews with McGill pain researchers whose investigations are funded by the Canadian Institutes for Health Research. The project, carried out in cooperation with The McGill Office for Chemistry and Society, aims to highlight recent advances in the study of pain. Permission is granted to reprint in whole or in part.