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      Sorting pain out of salience: assessment of pain facial expressions in the human fetus

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          Abstract

          Supplemental Digital Content is Available in the Text.

          Acute pain facial expressions can be detected/scored in human fetuses. We propose a seven-item scale to differentiate pain facial expressions from rest/acoustic stimuli ones.

          Abstract

          Introduction:

          The question of whether the human fetus experiences pain has received substantial attention in recent times. With the advent of high-definition 4-dimensional ultrasound (4D-US), it is possible to record fetal body and facial expressions.

          Objective:

          To determine whether human fetuses demonstrate discriminative acute behavioral responses to nociceptive input.

          Methods:

          This cross-sectional study included 5 fetuses with diaphragmatic hernia with indication of intrauterine surgery (fetoscopic endoluminal tracheal occlusion) and 8 healthy fetuses, who were scanned with 4D-US in 1 of 3 conditions: (1) acute pain group: Fetuses undergoing intrauterine surgery were assessed in the preoperative period during the anesthetic injection into the thigh; (2) control group at rest: Facial expressions at rest were recorded during scheduled ultrasound examinations; and (3) control group acoustic startle: Fetal facial expressions were recorded during acoustic stimulus (500–4000 Hz; 60–115 dB).

          Results:

          Raters blinded to the fetuses’ groups scored 65 pictures of fetal facial expressions based on the presence of 12 items (facial movements). Analyses of redundancy and usefulness excluded 5 items for being of low discrimination capacity (P>0.2). The final version of the pain assessment tool consisted of a total of 7 items: brow lowering/eyes squeezed shut/deepening of the nasolabial furrow/open lips/horizontal mouth stretch/vertical mouth stretch/neck deflection. Odd ratios for a facial expression to be detected in acute pain compared with control conditions ranged from 11 (neck deflection) to 1,400 (horizontal mouth stretch). Using the seven-item final tool, we showed that 5 is the cutoff value discriminating pain from nonpainful startle and rest.

          Conclusions:

          This study inaugurates the possibility to study pain responses during the intrauterine life, which may have implications for the postoperative management of pain after intrauterine surgical interventions

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          Most cited references39

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          STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT

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            The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises

            The current International Association for the Study of Pain (IASP) definition of pain as "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" was recommended by the Subcommittee on Taxonomy and adopted by the IASP Council in 1979. This definition has become accepted widely by health care professionals and researchers in the pain field and adopted by several professional, governmental, and nongovernmental organizations, including the World Health Organization. In recent years, some in the field have reasoned that advances in our understanding of pain warrant a reevaluation of the definition and have proposed modifications. Therefore, in 2018, the IASP formed a 14-member, multinational Presidential Task Force comprising individuals with broad expertise in clinical and basic science related to pain, to evaluate the current definition and accompanying note and recommend whether they should be retained or changed. This review provides a synopsis of the critical concepts, the analysis of comments from the IASP membership and public, and the committee's final recommendations for revisions to the definition and notes, which were discussed over a 2-year period. The task force ultimately recommended that the definition of pain be revised to "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage," and that the accompanying notes be updated to a bulleted list that included the etymology. The revised definition and notes were unanimously accepted by the IASP Council early this year.
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              Interoceptive inference, emotion, and the embodied self.

              The concept of the brain as a prediction machine has enjoyed a resurgence in the context of the Bayesian brain and predictive coding approaches within cognitive science. To date, this perspective has been applied primarily to exteroceptive perception (e.g., vision, audition), and action. Here, I describe a predictive, inferential perspective on interoception: 'interoceptive inference' conceives of subjective feeling states (emotions) as arising from actively-inferred generative (predictive) models of the causes of interoceptive afferents. The model generalizes 'appraisal' theories that view emotions as emerging from cognitive evaluations of physiological changes, and it sheds new light on the neurocognitive mechanisms that underlie the experience of body ownership and conscious selfhood in health and in neuropsychiatric illness. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Journal
                Pain Rep
                Pain Rep
                PAIREP
                Painreports
                Pain Reports
                Wolters Kluwer (Philadelphia, PA )
                2471-2531
                Jan-Feb 2021
                27 January 2021
                : 6
                : 1
                : e882
                Affiliations
                [a ]Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da FMUSP, Universidade de São Paulo, São Paulo, Brazil
                [b ]School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
                [c ]Hospital e Maternidade SEPACO, São Paulo, Brazil
                [d ]Instituto de Matemática e Estatística da Universidade de São Paulo, São Paulo, Brazil
                [f ]Computational Science Department Universidade Federal de Minas Gerais, Minas Gerais, Brazil
                [e ]Pain Center, LIM-62, Department of Neurology, University of São Paulo, São Paulo, Brazil
                [g ]Pain Center, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, University of São Paulo, São Paulo, Brazil
                Author notes
                [* ]Corresponding author. Address: Av. Dr. Enéas de Carvalho Aguiar, 255, 5º andar, Sala 5084, Cerqueira César 05403-900, São Paulo, Brazil. Tel./fax: +55-11-2661-7152. E-mail address: ciampi@ 123456usp.br (D. Ciampi de Andrade).
                Article
                PAINREPORTS-D-20-0059 00016
                10.1097/PR9.0000000000000882
                7850725
                33537520
                2b0aaf96-6011-471e-818c-47f5e9528a38
                Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 10 June 2020
                : 02 November 2020
                : 07 November 2020
                Categories
                9
                Pediatric
                Research Paper
                Custom metadata
                TRUE
                T

                pain,fetal,ultrasound
                pain, fetal, ultrasound

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