Fetal and neonatal pain beyond the smoking gun

Fetuses and newborns cannot verbally express their pain or the absence of pain. However, there is considerable evidence that at 20–22 weeks after conception, the response to potentially painful stimuli is similar to that of adults from an electrophysiological, chemical and behavioural perspective. The speech is yet absent, but authoritative scientific societies have shown that this does not rule out the presence of pain. To be sure of pain, the patient’s speech—as a sort of ‘smoking gun’—would be desirable; however, it is not indispensable in the presence of strong hints. The use of analgesics should not be recommended only in the case of physical consequences of potentially painful stimulations, as it emerges from Derbyshire’s paper, but also to avoid pain when it is highly likely to be present

Fetus · MEDLINE · Pain relief · Pregnancy · sort · Anesthesia and Pain Management · Human Factors and Ergonomics · Maternal and Perinatal Health Interventions · Pediatric Pain Management Techniques

• Assessing fetal and neonatal pain

  Stuart Derbyshire•Journal of Medical Ethics•2026

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