Läkartidningen
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Historical Article
[Pain--life's dreaded companion. Cultural history of algology and the most important achievements].
Pain is a comprehensive phenomenon which concerns not only physiology, biochemistry and molecular biology but also music, art, religion, philosophy and everyday life. The early contributions to the development of the specificity theory is described, as are some of the important discoveries in the history of algology, such as Baillou's description of rheumatism, Heberden's description of angina pectoris and the development of the gate control theory. Despite a number of important discoveries and a much improved knowledge in basic science pain is still the dreaded companion of mankind.
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In about 10 per cent of children with cerebral palsy, the most probable cause is birth asphyxia. The brain injury following birth asphyxia evolves in part over hours or days--as a secondary process. This opens a 'window of opportunity' for intervention. ⋯ Pilot trials of cooling suggest that the side-effects of cooling can be managed. Randomized controlled trials are underway. Obtaining informed consent from the parents for these trials represents a particular challenge.
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General anesthesia induces hypothermia due to decreased metabolic rate and impaired thermoregulation. Adverse effects of hypothermia are common. Many warming devices are in use to prevent heat loss, but little attention has been paid to stimulating the body's own heat generation. ⋯ During anesthesia the thermogenic effect of i.v. amino acids was increased. The results support the existence of an inhibitory action normally exerted by central thermosensors in order to prevent hyperthermia. During anesthesia, central thermosensors are impaired, and hence amino acid thermogenesis is exaggerated, which may prevent hypothermia.
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The neonate has a functional nociceptive system. However, recent research suggests that infants may be more vulnerable to the negative effects of pain than older children and adults. Apart from short-term effects, untreated pain may also have long-term effects, which may later affect neurological development, including the reaction to pain. Despite convincing evidence from recent research, the neonate is still subjected to painful procedures, even surgery, without adequate treatment.