A CHILD'S PAIN

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But of course they do. In fact, Berde says, research has shown that babies actually feel more pain than older patients--longer-lasting, more widespread pain that is likely to affect their behavior later in life. Pain unleashes a destructive cascade of stress hormones that can weaken the immune system and make the heart rate and blood pressure soar. Studies in the 1970s and '80s showed that babies deprived of anesthesia during surgery were more likely to develop infections, brain hemorrhages, muscle wasting and difficulties in healing.

Those findings, combined with advances that have greatly reduced the risks from anesthesia during the past 10 to 15 years, have brought about some substantial changes. "Now no newborn is too sick to get pain medication," Berde says. In general, there seems to be more effort to reduce kids' pain from all medical procedures, including bone-marrow biopsies, spinal taps and repeated blood drawings. Says Berde: "I think most major children's hospitals are changing. There is less willingness than there used to be to hold kids down and brutalize them."

There is still room for improvement, though. Families with children who need surgery are traveling long distances to Children's, specifically because they have had bad experiences with pain control in other hospitals. In addition, not enough research is being done on pain medication for children because, Berde believes, drug companies do not think children are a large enough market. Too many babies are still being circumcised without anesthesia, in Berde's opinion; he thinks that at the very least a numbing cream should be used but that general anesthetics and nerve blocks are more effective. "You couldn't go into an animal lab and do a procedure like that without anesthesia," he says.

One of Berde's research interests is developing local anesthetics that will work for days or a week after surgery instead of for six hours, as existing drugs do. Prolonged pain after chest or abdominal surgery is not just unpleasant; it can be harmful as well, keeping a patient from taking deep breaths or coughing--things they need to do. Pain can also keep people bedridden, impeding their recovery. "Our major aim is to get people up quickly," Berde says. "They're less likely to develop pneumonia, lose muscle mass and have trouble sleeping." Ambulatory adults are also less prone to blood clots, heart attacks and mental confusion.

But pain killers now in use have drawbacks. Morphine, codeine and related drugs, given by mouth or intravenously, can cause such side effects as nausea, constipation and itching. Epidural blocks can lead to similar problems. In addition, they must usually be removed before the patient goes home, even though he or she may still be in pain. Berde has found that many people are reluctant to take pain medication at home, or give it to their children, in the mistaken fear that they will become addicts.