Santella Tanya M, Richebé Philippe, Godin Nadia, Brulotte Véronique
Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, 5415 boul. L'Assomption, Montreal, QC, H1T 2M4, Canada.
J Clin Monit Comput. 2022 Dec;36(6):1851-1858. doi: 10.1007/s10877-022-00835-z. Epub 2022 Mar 8.
The nociception level index (NOL) is a multi-parameter index that incorporates changes in autonomic parameters to evaluate nociception, with more painful stimuli causing more pronounced index variations. How this nociception monitor relates to the pain experience is uncertain, and patients with chronic pain may respond differently to acute pain due to alterations in pain processing. The goal of this pilot study was to evaluate NOL index variations after a painful physiotherapy exercise in patients with upper limb complex regional pain syndrome. Baseline NOL indexes were recorded using a finger probe (PMD-200™ Monitor, Medasense, Israel) and patient reported baseline pain scores using an 11-point numeric rating scale (NRS). Patients then performed a painful physiotherapy exercise and NOL index and pain scores were again recorded. The same procedure and recordings were repeated after a stellate ganglion block. Data were analyzed using a paired Student T test and a P value < 0.05 was considered statistically significant. Twenty patients (12/20 female, 10/20 right-sided) were included in this study. Patients reported moderate baseline pain (4.0 ± 2.7) despite having a low baseline NOL index (7.66 ± 5.76 out of 100). NRS and NOL index scores increased significantly during exercise, both before and after the block. The NOL index increased significantly when patients reported increased pain, indicating that it could eventually be useful in the objective assessment of acute pain in the chronic pain patients. However, NOL index was not able to reflect pain levels at rest, before the painful stimulation, in this chronic pain population. Further studies are needed to better assess NOL index utility at rest and to confirm these findings in this specific chronic pain population.
伤害感受水平指数（NOL）是一个多参数指数，它纳入自主神经参数的变化来评估伤害感受，疼痛刺激越强，指数变化越明显。这种伤害感受监测器与疼痛体验之间的关系尚不确定，慢性疼痛患者由于疼痛处理过程的改变，对急性疼痛的反应可能不同。本初步研究的目的是评估上肢复杂性区域疼痛综合征患者进行疼痛性物理治疗运动后的NOL指数变化。使用手指探头（PMD-200™监测仪，Medasense，以色列）记录基线NOL指数，并使用11点数字评分量表（NRS）让患者报告基线疼痛评分。然后患者进行疼痛性物理治疗运动，并再次记录NOL指数和疼痛评分。星状神经节阻滞术后重复相同的程序和记录。使用配对学生t检验分析数据，P值<0.05被认为具有统计学意义。本研究纳入了20例患者（12/20为女性，10/20为右侧）。尽管基线NOL指数较低（100分中为7.66±5.76），但患者报告有中度基线疼痛（4.0±2.7）。在运动期间，无论是阻滞前还是阻滞后，NRS和NOL指数评分均显著增加。当患者报告疼痛增加时，NOL指数显著增加，这表明它最终可能有助于客观评估慢性疼痛患者的急性疼痛。然而，在这个慢性疼痛人群中，NOL指数在疼痛刺激前并不能反映静息时的疼痛水平。需要进一步研究以更好地评估静息时NOL指数的效用，并在这个特定的慢性疼痛人群中证实这些发现。
