Charité, Universitätsmedizin Berlin, Department of Anesthesiology, Germany.
Clin Neurophysiol. 2010 Jun;121(6):945-9. doi: 10.1016/j.clinph.2010.01.012. Epub 2010 Feb 23.
The nociceptive blink reflex is a trigeminofacial brain-stem reflex which is used in pain research to evaluate the modulation of pain processing. To standardize the analysis of the reflex we investigated which electromyographic parameters show the best correlation with subjective pain ratings and should therefore be used for scoring blink reflex magnitude. Furthermore we investigated which parameters show the highest accuracy and reliability to define the blink reflex threshold.
Forty-six subjects each received 54 electrical stimuli to the supraorbital nerve at nine different stimulus intensities, which corresponded to pain ratings between 0 and 70 (scale 0-100). Multilevel modeling was performed to determine which electromyographic blink reflex parameter showed the best correlation with subjective pain ratings. To define the blink reflex threshold ROC analyses were performed, comparing different electromyographic blink reflex parameters with the judgment of expert raters for 2500 blink reflex recordings from this study and 1400 from another.
The baseline-adjusted area under the curve showed the best correlation with subjective pain ratings. Seventy-six percent of the residual variance of the pain ratings could be explained by this parameter. The peak z score showed the highest accuracy in defining the blink reflex threshold and also the highest cut-point stability.
We recommend the baseline-adjusted area under the curve for scoring the magnitude of the nociceptive blink reflex and the peak z score to define the nociceptive blink reflex threshold.
The here defined standardized criteria to score blink reflex magnitude and threshold improve the comparability and validity of blink reflex studies.
伤害性眨眼反射是一种三叉面神经脑反射，用于疼痛研究中评估疼痛处理的调制。为了规范反射分析，我们研究了哪些肌电图参数与主观疼痛评分相关性最好，因此应用于评分眨眼反射幅度。此外，我们还研究了哪些参数在定义眨眼反射阈值方面具有最高的准确性和可靠性。
46 名受试者每人接受 54 次眶上神经电刺激，刺激强度为 9 个不同水平，对应于 0 至 70 的疼痛评分（0-100 量表）。采用多级模型确定与主观疼痛评分相关性最好的肌电图眨眼反射参数。为了定义眨眼反射阈值，我们对不同的肌电图眨眼反射参数进行了 ROC 分析，将这些参数与来自这项研究的 2500 次眨眼反射记录和来自另一项研究的 1400 次眨眼反射记录的专家评分进行了比较。
基线调整后的曲线下面积与主观疼痛评分相关性最好。该参数可解释疼痛评分的 76%的剩余方差。峰值 z 分数在定义眨眼反射阈值方面具有最高的准确性和最高的截断点稳定性。
我们建议使用基线调整后的曲线下面积来评分伤害性眨眼反射的幅度，以及峰值 z 分数来定义伤害性眨眼反射阈值。
这里定义的评分眨眼反射幅度和阈值的标准化标准提高了眨眼反射研究的可比性和有效性。
