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To the Editor: Dr Lee and colleagues¹ provided a Clinical Review of fetal pain. I believe that the conclusions the authors have reached are inaccurate and ethically disturbing. First, as the authors correctly state, the definition of pain for treatment and research purposes is the subjective phenomenon of potential or actual tissue damage.² It is therefore impossible to directly study pain in the fetus. This is why the authors emphasized, as a surrogate, the histological studies examining the development of the thalamocortical circuits and conclude based on these limited data that the fetus cannot experience pain. However, in the literature that they cited, the timing of thalamic projections to specific cortical end points ranged from 21 to 30 weeks' gestational age. By these standards, the fetus could be experiencing pain as early as 21 weeks.

I would without question provide a full anesthetic to a 24-week neonate presenting to the . . . [Full Text of this Article]

Brian D. Sites, MD
brian.sites@hitchcock.org
Department of Anesthesiology
Dartmouth-Hitchcock Medical Center
Lebanon, NH

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