Nociceptive brain activity as a measure of analgesic efficacy in infants

Abstract

Pain in infants is under-treated and poorly understood, representing a significant clinical problem. In part, this is due to our inability to objectively measure pain in non-verbal populations. Here, we present an EEG-based measure of infant nociceptive brain activity that is evoked following acute noxious stimulation and is sensitive to analgesic modulation. This measure will be valuable for both mechanistic investigations and for testing analgesic efficacy in the infant population.

Infants born preterm, stress, and neurodevelopment in the neonatal intensive care unit: might music have an impact?

“…The dependent measures for future studies should include not only established physiological measures such as arterial oxygen saturation level, heart rate, and respiratory rate, but objective measures of HPA activation/regulation (e.g. cortisol and β ‐endorphins) and pain (perhaps through the recently identified nociceptive electroencephalography wave) …”

Multimodal pain assessment improves discrimination between noxious and non‐noxious stimuli in infants

“…As pain is a subjective experience and necessarily involves cortical activity, measuring brain activity can provide important insight into how nociceptive input is processed by the brain. However, the template of noxious‐evoked brain activity that has previously been derived is limited as it does not measure all nociceptive activity that takes place across the infant's brain . Furthermore, the sensitivity and specificity of this measure for individual infants was previously noted to be only moderate (approximately 65%) .…”

“…However, the template of noxious‐evoked brain activity that has previously been derived is limited as it does not measure all nociceptive activity that takes place across the infant's brain . Furthermore, the sensitivity and specificity of this measure for individual infants was previously noted to be only moderate (approximately 65%) . While developing a validated signature of noxious‐evoked brain activity which incorporates other features (such as the data acquired from fMRI studies ) will add additional information, inclusion of noxious‐evoked brain activity in the full multimodal model in this study (measured using the validated template) provided increased power to discriminate noxious from non‐noxious procedures.…”

Beyond the Randomized Clinical Trial: Innovative Data Science to Close the Pediatric Evidence Gap

“…For example, Hartley et al used electroencephalography data to derive a summary measure for nociceptive brain activity in infants. 56 In this example, the electroencephalography-based measure of pain was learned from the context (i.e., by comparing the response profiles after non-noxious or noxious stimulation). In another example, a supervised learning approach was used to derive a measure of iatrogenic withdrawal severity in children by combined analysis of nurse's expert opinion of the child's withdrawal severity and the observed withdrawal symptoms.…”