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

Lisandra S Bernardes; Mariana A Carvalho; Simone B Harnik; Manoel J Teixeira; Juliana Ottolia; Daniella Castro; Adriano Velloso; Rossana Francisco; Clarice Listik; Ricardo Galhardoni; Valquiria Aparecida da Silva; Larissa I Moreira; Antonio G de Amorim Filho; Ana M Fernandes; Daniel Ciampi de Andrade

doi:10.1097/PR9.0000000000000882

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

Lisandra S Bernardes, Mariana A Carvalho, Simone B Harnik, Manoel J Teixeira, Juliana Ottolia, Daniella Castro, Adriano Velloso, Rossana Francisco, Clarice Listik, Ricardo Galhardoni, Valquiria Aparecida da Silva, Larissa I Moreira, Antonio G de Amorim Filho, Ana M Fernandes, Daniel Ciampi de Andrade

Research output: Contribution to journal › Journal article › Research › peer-review

14 Citations (Scopus)

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.

Original language	English
Article number	e882
Journal	Pain Reports
Volume	6
Issue number	1
ISSN	2471-2531
DOIs	https://doi.org/10.1097/PR9.0000000000000882
Publication status	Published - 5 Feb 2021
Externally published	Yes

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Bernardes, L. S., Carvalho, M. A., Harnik, S. B., Teixeira, M. J., Ottolia, J., Castro, D., Velloso, A., Francisco, R., Listik, C., Galhardoni, R., Aparecida da Silva, V., Moreira, L. I., de Amorim Filho, A. G., Fernandes, A. M., & Ciampi de Andrade, D. (2021). Sorting pain out of salience: assessment of pain facial expressions in the human fetus. Pain Reports, 6(1), Article e882. https://doi.org/10.1097/PR9.0000000000000882

@article{c38b94f8019842129902531ee7d5c940,

title = "Sorting pain out of salience: assessment of pain facial expressions in the human fetus",

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.",

author = "Bernardes, {Lisandra S} and Carvalho, {Mariana A} and Harnik, {Simone B} and Teixeira, {Manoel J} and Juliana Ottolia and Daniella Castro and Adriano Velloso and Rossana Francisco and Clarice Listik and Ricardo Galhardoni and {Aparecida da Silva}, Valquiria and Moreira, {Larissa I} and {de Amorim Filho}, {Antonio G} and Fernandes, {Ana M} and {Ciampi de Andrade}, Daniel",

note = "Copyright {\textcopyright} 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.",

year = "2021",

month = feb,

day = "5",

doi = "10.1097/PR9.0000000000000882",

language = "English",

volume = "6",

journal = "Pain Reports",

issn = "2471-2531",

publisher = "International Association for the Study of Pain",

number = "1",

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Bernardes, LS, Carvalho, MA, Harnik, SB, Teixeira, MJ, Ottolia, J, Castro, D, Velloso, A, Francisco, R, Listik, C, Galhardoni, R, Aparecida da Silva, V, Moreira, LI, de Amorim Filho, AG, Fernandes, AM & Ciampi de Andrade, D 2021, 'Sorting pain out of salience: assessment of pain facial expressions in the human fetus', Pain Reports, vol. 6, no. 1, e882. https://doi.org/10.1097/PR9.0000000000000882

TY - JOUR

T1 - Sorting pain out of salience

T2 - assessment of pain facial expressions in the human fetus

AU - Bernardes, Lisandra S

AU - Carvalho, Mariana A

AU - Harnik, Simone B

AU - Teixeira, Manoel J

AU - Ottolia, Juliana

AU - Castro, Daniella

AU - Velloso, Adriano

AU - Francisco, Rossana

AU - Listik, Clarice

AU - Galhardoni, Ricardo

AU - Aparecida da Silva, Valquiria

AU - Moreira, Larissa I

AU - de Amorim Filho, Antonio G

AU - Fernandes, Ana M

AU - Ciampi de Andrade, Daniel

PY - 2021/2/5

Y1 - 2021/2/5

N2 - 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.

AB - 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.

U2 - 10.1097/PR9.0000000000000882

DO - 10.1097/PR9.0000000000000882

M3 - Journal article

C2 - 33537520

SN - 2471-2531

VL - 6

JO - Pain Reports

JF - Pain Reports

IS - 1

M1 - e882

ER -

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

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