Eisenried Andreas, Austin Naola, Cobb Benjamin, Akhbardeh Alireza, Carvalho Brendan, Yeomans David C, Tzabazis Alexander Z
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA,
Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany.
J Pain Res. 2018 Sep 24;11:1991-1998. doi: 10.2147/JPR.S162839. eCollection 2018.
Noninvasive cerebral optical spectrometry is a promising candidate technology for the objective assessment physiological changes during pain perception. This study's primary objective was to test if there was a significant correlation between the changes in physiological parameters as measured by a cerebral optical spectrometry-based algorithm (real-time objective pain assessment [ROPA]) and subjective pain ratings obtained from volunteers and laboring women. Secondary aims were performance assessment using linear regression and receiver operating curve (ROC) analysis.
Prospective cohort study performed in Human Pain Laboratory and Labor and Delivery Unit. After institutional review board approval, we evaluated ROPA in volunteers undergoing the cold pressor test and in laboring women before and after epidural or combined spinal epidural placement. Linear regression was performed to measure correlations. ROCs and corresponding areas under the ROCs (AUC), as well as Youden's indices, as a measure of diagnostic effectiveness, were calculated.
Correlations between numeric rating scale or visual analog scale and ROPA were significant for both volunteers and laboring women. AUCs for both volunteers and laboring women with numeric rating scale and visual analog scale subjective pain ratings as ground truth revealed at least good (AUC: 70%-79%) to excellent (AUC >90%) distinction between clinically meaningful pain severity differentiations (no/mild-moderate-severe).
Cerebral Optical Spectrometry-based ROPA significantly correlated with subjectively reported pain in volunteers and laboring women, and could be a useful monitor for clinical circumstances where direct assessment is not available, or to complement patient-reported pain scores.
无创脑光学光谱法是一种很有前景的候选技术，可用于客观评估疼痛感知过程中的生理变化。本研究的主要目的是测试基于脑光学光谱法的算法（实时客观疼痛评估[ROPA]）所测量的生理参数变化与志愿者和分娩妇女的主观疼痛评分之间是否存在显著相关性。次要目的是使用线性回归和受试者工作特征曲线（ROC）分析进行性能评估。
在人类疼痛实验室和产房进行前瞻性队列研究。经机构审查委员会批准后，我们对接受冷加压试验的志愿者以及硬膜外或腰麻-硬膜外联合麻醉前后的分娩妇女进行了ROPA评估。进行线性回归以测量相关性。计算ROC及其相应的曲线下面积（AUC），以及约登指数，作为诊断有效性的指标。
对于志愿者和分娩妇女，数字评分量表或视觉模拟量表与ROPA之间的相关性均显著。以数字评分量表和视觉模拟量表主观疼痛评分为金标准，志愿者和分娩妇女的AUC显示，在临床上有意义的疼痛严重程度差异（无/轻-中-重度）之间至少有良好（AUC：70%-79%）到优秀（AUC>90%）的区分度。
基于脑光学光谱法的ROPA与志愿者和分娩妇女主观报告的疼痛显著相关，在无法进行直接评估的临床情况下，或作为患者报告疼痛评分的补充时，它可能是一种有用的监测工具。
