22,335
edits
Changes
Jump to navigation
Jump to search
<blockquote>{{Citation |Text=Although postsurgical central sensitisation (allodynia and hyperalgesia) can extend to sites of the body distal from the wound, suggesting a supraspinal effect, the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an <u>infant analogue of a post-traumatic stress disorder</u> triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination. |Author=Taddio et al. (1997) |ref=<ref name="taddio1997" /></blockquote>}}
<blockquote>{{Citation |Text=The public health importance of abnormal stimulation during the neonatal period cannot be overemphasized. While programs for formulating appropriate health policies and public education campaigns must disseminate this message, it is also important for these effects to be investigated, particularly with a view to developing effective therapeutic strategies for the growing childen and adolescents who were exposed to abnormal conditions during the neonatal period. |Author=Anand & Scalzo (2000) |ref=<ref name="anand2000">{{REFjournal
</blockquote>}}
<blockquote>: {{Citation |Text=Neonatal circumcision is performed without anesthesia and it is clearly stressful for the infant.</blockquote> |Author=Gunnar et al. (1981)So great was Flechsig's influence, the authors were still unwilling to use the word ''pain'' and substituted the word ''stress''. |ref=<refname="Gunnar et al 1981">{{REFjournal
<blockquote>{{Citation<i> |Text=Numerous lines of evidence suggest that even in the human [[fetus]], pain pathways as well as cortical and subcortical centers necessary for pain perception are well developed late in gestation, and the neurochemical systems now known to be associated with pain transmission and modulation are intact and functional. Physiologic responses to painful stimuli have been well documented in neonates of various gestational ages and are reflected in hormonal, metabolic, and cardiorespiratory changes similar to but greater than those observed in adult subjects. Other responses in newborn infants are suggestive of integrated emotional and behavioral responses to pain and are retained in memory long enough to modify subsequent behavior patterns.</i> |Author=Anand & Hickey (1987) |ref=<ref name="anand1987"/><ref name="vanhowe2008"/></blockquote></i>}}
<blockquote>{{Citation |Text=Despite evidence that neonates perceive pain and that there is a physiologic stress response to circumcision which can be reduced if analgesia is employed, the vast majority of physicians performing newborn circumcisions either do not employ analgesics or employ analgesics of questionable efficacy. Lack of familiarity with the use of analgesics among neonates and with dorsal penile block in particular are the most common reasons cited for lack of analgesic use. Educational efforts and research into less invasive techniques of analgesia for newborn circumcision are urgently required. |Author=Wellington & Rieder (1993) |ref=<ref>{{REFjournal
</blockquote>}}
<blockquote>{{Citation |Text=DESPITE THE DEBATE that continues over the benefits and risks of nonritual neonatal circumcision, it remains a commonly performed surgical procedure in the United States. To the best of our knowledge, it is the only surgical procedure that is routinely performed without first administering analgesia or anesthesia. This unconscionable state of affairs exists, despite the overwhelming evidence that newborns, even those born prematurely, are capable of experiencing pain. Indeed, anyone present during a circumcision realizes that the newborn feels and responds to pain and will attempt to withdraw if unrestrained. In addition, this pain has physiologic correlates: elevated heart rate and blood pressure, lowered arterial oxygen saturation, and elevated levels of adrenocortical hormones. During the past 15 years, results of a multitude of studies have demonstrated that effective analgesia can prevent this pain and ameliorate the associated stress response. Furthermore, the failure to provide anesthesia or analgesia has been shown to cause not only short-term physiologic perturbations but also longer-term behavioral changes. |Author=Maxwell & Yaster (1999) |ref=<ref>{{REFjournal
</blockquote>}}
Pain
,converted blockquotes to citations
Taddio et al. (1997) concluded:
John Rhinehart, {{MD}}, (1999) a clinical psychiatrist, reported finding numerous cases of PTSD in his adult male patients pursuant to infant circumcision.<ref>{{REFjournal
===Effect of extreme pain on developing nervous system===
Several researchers have suggested that extreme pain in the newborn could cause neurological injury. Anand & Scalzo (2000) concluded:
|last=Anand
|first=
|accessdate=2021-08-09
}}</ref>
Fitzgerald & Walker (2003) argued that extreme pain (such as that caused by circumcision) may alter developing nervous tissue in the very young.<ref>{{REFbook
|last=Fitzgerald
* Gunnar et al. (1981) recorded serum cortisol and behavior state throughout the unanesthetized, non-therapeutic circumcision process. Serum cortisol levels and behavioral distress were found to be closely related. The authors stated:
|last=Gunnar
|init=MR
|accessdate=2020-11-13
}}</ref>
}}
So great was Flechsig's influence, the authors were still unwilling to use the word ''pain'' and substituted the word ''stress''.<ref name="Gunnar et al 1981"/>
* Marshall et al. (1982) studied mother-child interaction with regard to feeding behavior after circumcision without anesthesia. They found that circumcised boys had more interruptions of feeding in the 24-hour period of observation.<ref name="marshall1982">{{REFjournal
Anand & Hickey (1987) published a paper in the ''New England Journal of Medicine'' that totally demolished Flechsig's ridiculous claims and conclusively proved that newborn infants are capable of feeling intense pain. After publication of this paper, no doubt about pain sensation in infants remained. The article stated:
Gunnar et al. (1988) examined the association between behavioral distress and adrenocortical activity. It was found that differences in behavioral distress did not reliably the level of adrenocortical activity. Moreover, it was found that while non-nutritive sucking reduces crying it did not reduce the adrenocortical response to the stressful stimulus of circumcision pain.<ref name="gunnar1988">{{REFjournal
Wellington & Rieder (1993) conducted a survey of physicians in London, Ontario. They found that only 4 percent used DPNB. They concluded:
|last=Wellington
|first=Nancy
|accessdate=2020-11-18
}}</ref>
Ryan & Finer (1994) carried out a training program for physicians in the newborn nurseries of the Womens' Pavilion, [https://www.albertahealthservices.ca/rah/rah.aspx Royal Alexandra Hospital], Edmonton, Alberta, Canada. After a training program, they found that 66 percent of physicians who perform non-therapeutic neonatal circumcisions had started to use analgesia during the procedure. This applies to one hospital in [[Canada]].<ref name="ryan1994">{{REFjournal
Maxwell & Yaster (1999) called on physicians to use analgesia during neonatal non-therapeutic circumcision surgery, saying:
|last=Maxwell
|init=
|accessdate=2020-11-21
}}</ref>
The [[American Academy of Pediatrics]] convened a new task force on circumcision under the chair of Carole M. Lannon, {{MD}}. That task force reversed the position previously taken under [[Edgar J. Schoen]]. It clearly stated that non-therapeutic infant circumcision is "not essential to the child’s current well-being." It provided an extensive discussion of procedural analgesia and said, quite strongly, that, if a circumcision is done, procedural analgesia should be provided.<ref name="aap1999">{{REFjournal