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Gerald N. Weiss, MD
Little Rock, Ark

JAMA. 1988;260(5):637-638.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The ORIGINAL CONTRIBUTION by Stang et al¹ is a commendable scientific study, but it may be based on questionable assumptions. It has never been proved that a neonate undergoing surgery experiences pain. In 1987, Fitzgerald² reported the following:

Understanding and treatment of infant pain depends on the wider study of developmental processes. As yet, this is just beginning. It is apparent in rats that peripheral nociceptors develop prenatally, but levels of peptides and other neurochemicals within their terminals build up slowly over the postnatal period. Furthermore, substance P receptors in the spinal cord initially are distributed diffusely and become localized postnatally. Cells in the dorsal horn that process nociceptive information have poorly organized responses at birth and develop segmental and descending controls postnatally. Enkephalin levels within the spinal cord also increase postnatally, and there is a differential development of opiate receptors, with K-receptors appearing first . . . [Full Text PDF of this Article]

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