Meyer-Frießem Christine H, Jess Gunnar, Pogatzki-Zahn Esther M, Zahn Peter K
Department of Anaesthesiology, Intensive Care Medicine, Palliative Care and Pain Management, BG-Universitätsklinikum Bergmannsheil GmbH Bochum, Medical Faculty of Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
Department of Anaesthesiology, Intensive Care Medicine, Palliative Care and Pain Management, BG-Universitätsklinikum Bergmannsheil GmbH Bochum, Medical Faculty of Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
Scand J Pain. 2017 Jul;16:129-135. doi: 10.1016/j.sjpain.2017.05.001. Epub 2017 May 25.
Pain assessment by Numeric Rating Scale (NRS) is considered to be good clinical practice, but objective pain assessment is still a challenge. Near infrared spectroscopy (NIRS) measures cerebral tissue oxygen saturation (SctO) that increases with cortical-neuronal activity and may provide point-of-care bedside pain monitoring. Analogous to promising studies in newborns, we hypothesize that different levels of SctO can probably quantify pain intensity. SctO may increase following painful in contrast to non-painful or sham stimuli and may correlate with pain intensity as assessed by NRS in volunteers.
Twenty healthy male students (24.2±1.9 years), recruited via local advertising, were consecutively included in a sequence-randomized, sham-controlled, single-blinded study. SctO was recorded continuously with two NIRS sensors on the forehead. After resting, four stimuli were applied in a random order on the right forearm (unexpected and expected electrical pain, expected non-painful and sham stimuli). Blinded subjects were asked to rate each stimulus on NRS.
RM-ANOVA; Wilcoxon or paired Student t-test; Spearman's rank correlation; P<.05.
Resting volunteers showed SctO of 72.65%±3.39. SctO significantly increased for about 60 to 70s until a maximum after unexpected painful (74.62%±3.9; P=.022) and sham stimuli (74.07%±3.23; P=.014). Expected painful (P=.139) and non-painful stimuli (P=.455) resulted in no changes in SctO. NRS scores (median, IQR) were rated significantly higher after expected (5.25, 3.5 to 6.75) than after unexpected (4.5, 3 to 5; P=.008) pain. No strong correlation was found between NRS and SctO.
Contrary to our expectations, measuring SctO via a two-channel NIRS is not able to remediate the lack of objective bedside pain assessment under standardized experimental conditions in alert adults.
DRKS 00011575 (retrospectively registered).
采用数字评分量表（NRS）进行疼痛评估被认为是良好的临床实践，但客观的疼痛评估仍然是一项挑战。近红外光谱（NIRS）可测量随皮质神经元活动增加的脑组织氧饱和度（SctO），并可能提供即时床边疼痛监测。类似于在新生儿中开展的前景良好的研究，我们假设不同水平的SctO可能能够量化疼痛强度。与非疼痛或假刺激相比，疼痛刺激后SctO可能会升高，且可能与志愿者通过NRS评估的疼痛强度相关。
通过当地广告招募的20名健康男性学生（24.2±1.9岁）连续纳入一项序列随机、假对照、单盲研究。使用两个NIRS传感器在前额连续记录SctO。休息后，在右前臂以随机顺序施加四种刺激（意外和预期的电疼痛、预期的非疼痛和假刺激）。要求不知情的受试者用NRS对每种刺激进行评分。
重复测量方差分析；Wilcoxon检验或配对t检验；Spearman等级相关；P<0.05。
休息时志愿者的SctO为72.65%±3.39。意外疼痛刺激（74.62%±3.9；P=0.022）和假刺激（74.07%±3.23；P=0.014）后，SctO显著升高约60至70秒直至达到最大值。预期疼痛刺激（P=0.139）和非疼痛刺激（P=0.455）导致SctO无变化。预期疼痛刺激后的NRS评分（中位数，四分位间距）（5.25，3.5至6.75）显著高于意外疼痛刺激后的评分（4.5，3至5；P=0.008）。未发现NRS与SctO之间有强相关性。
与我们的预期相反，在标准化实验条件下，通过双通道NIRS测量SctO无法弥补清醒成年人缺乏客观床边疼痛评估的问题。
DRKS 00011575（追溯注册）。
