Cerebral oxygenation for pain monitoring in adults is ineffective: A sequence-randomized, sham controlled study in volunteers

Cerebral oxygenation for pain monitoring in adults is ineffective: A sequence-randomized, sham... AbstractBackgroundPain 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 (SctO2) 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 SctO2 can probably quantify pain intensity. SctO2 may increase following painful in contrast to non-painful or sham stimuli and may correlate with pain intensity as assessed by NRS in volunteers.MethodsTwenty healthy male students (24.2±1.9 years), recruited via local advertising, were consecutively included in a sequence-randomized, sham-controlled, single-blinded study. SctO2 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. Statistics: RM-ANOVA; Wilcoxon or paired Student t-test; Spearman’s rank correlation; P < .05.ResultsResting volunteers showed SctO2 of 72.65%±3.39. SctO2 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 SctO2. 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 SctO2.Conclusions and ImplicationsContrary to our expectations, measuring SctO2 via a two-channel NIRS is not able to remediate the lack of objective bedside pain assessment under standardized experimental conditions in alert adults. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Cerebral oxygenation for pain monitoring in adults is ineffective: A sequence-randomized, sham controlled study in volunteers

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Publisher
De Gruyter
Copyright
© 2017 Scandinavian Association for the Study of Pain
ISSN
1877-8860
eISSN
1877-8879
D.O.I.
10.1016/j.sjpain.2017.05.001
Publisher site
See Article on Publisher Site

Abstract

AbstractBackgroundPain 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 (SctO2) 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 SctO2 can probably quantify pain intensity. SctO2 may increase following painful in contrast to non-painful or sham stimuli and may correlate with pain intensity as assessed by NRS in volunteers.MethodsTwenty healthy male students (24.2±1.9 years), recruited via local advertising, were consecutively included in a sequence-randomized, sham-controlled, single-blinded study. SctO2 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. Statistics: RM-ANOVA; Wilcoxon or paired Student t-test; Spearman’s rank correlation; P < .05.ResultsResting volunteers showed SctO2 of 72.65%±3.39. SctO2 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 SctO2. 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 SctO2.Conclusions and ImplicationsContrary to our expectations, measuring SctO2 via a two-channel NIRS is not able to remediate the lack of objective bedside pain assessment under standardized experimental conditions in alert adults.

Journal

Scandinavian Journal of Painde Gruyter

Published: Dec 29, 2017

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