Objective Assessment of Acute Pain

Laycock, Helen; Bantel, Carsten

doi:10.4172/2155-6148.1000630

Cited by 5 publications

(6 citation statements)

References 40 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, we investigated the pattern of subjective and physiological responses to cold pain stimuli and whether they were influenced by past or current pain experiences. As the limitations of self-reporting have increased, there have been numerous attempts to investigate pain responses in terms of biological parameters (Laycock and Bantel, 2016;Subramaniam et al, 2018). However, these studies have rarely considered contextual changes in pain.…”

Section: Discussionmentioning

confidence: 99%

Does past/current pain change pain experience? Comparing self-reports and pupillary responses

Yoo

Cho²,

Cho³

2023

Front. Psychol.

View full text Add to dashboard Cite

IntroductionFor decades, a substantial body of research has confirmed the subjective nature of pain. Subjectivity seems to be integrated into the concept of pain but is often confined to self-reported pain. Although it seems likely that past and current pain experiences would interact and influence subjective pain reports, the influence of these factors has not been investigated in the context of physiological pain. The current study focused on exploring the influence of past/current pain on self-reporting and pupillary responses to pain.MethodsOverall, 47 participants were divided into two groups, a 4°C–10°C group (experiencing major pain first) and a 10°C–4°C group (experiencing minor pain first), and performed cold pressor tasks (CPT) twice for 30 s each. During the two rounds of CPT, participants reported their pain intensity, and their pupillary responses were measured. Subsequently, they reappraised their pain ratings in the first CPT session.ResultsSelf-reported pain showed a significant difference (4°C–10°C: p = 0.045; 10°C–4°C: p < 0.001) in the rating of cold pain stimuli in both groups, and this gap was higher in the 10°C–4°C group than in the 4°C–10°C group. In terms of pupillary response, the 4°C–10°C group exhibited a significant difference in pupil diameter, whereas this was marginally significant in the 10°C–4°C group (4°C–10°C: p < 0.001; 10°C–4°C: p = 0.062). There were no significant changes in self-reported pain after reappraisal in either group.DiscussionThe findings of the current study confirmed that subjective and physiological responses to pain can be altered by previous experiences of pain.

show abstract

Section: Discussionmentioning

confidence: 99%

Does past/current pain change pain experience? Comparing self-reports and pupillary responses

Yoo

Cho²,

Cho³

2023

Front. Psychol.

View full text Add to dashboard Cite

show abstract

“…Pain assessment should ideally use self reported scales such as the numeric rating scale (Chanques et al, 2010), however, this can be limited by functional disability from critical illness. It is imperative to ensure pain is evaluated by an alternative method in the non-communicative patient (Laycock and Bantel, 2016). Here, the ACCM recommend using The Behavioral Pain Scale (BPS) or the Critical-Care Pain Observation Tool (CPOT) (Barr et al, 2013; Devlin et al, 2018).…”

Section: Methodsmentioning

confidence: 99%

Chronic Pain and Chronic Opioid Use After Intensive Care Discharge – Is It Time to Change Practice?

et al. 2019

Self Cite

View full text Add to dashboard Cite

Almost half of patients treated on intensive care unit (ICU) experience moderate to severe pain. Managing pain in the critically ill patient is challenging, as their pain is complex with multiple causes. Pharmacological treatment often focuses on opioids, and over a prolonged admission this can represent high cumulative doses which risk opioid dependence at discharge. Despite analgesia the incidence of chronic pain after treatment on ICU is high ranging from 33–73%. Measures need to be taken to prevent the transition from acute to chronic pain, whilst avoiding opioid overuse. This narrative review discusses preventive measures for the development of chronic pain in ICU patients. It considers a number of strategies that can be employed including non-opioid analgesics, regional analgesia, and non-pharmacological methods. We reason that individualized pain management plans should become the cornerstone for critically ill patients to facilitate physical and psychological well being after discharge from critical care and hospital.

show abstract

“…Short-term blood pressure variability (BPV) is an interesting variable for assessing nociception and analgesia, as the autonomic responses of heart rate and blood pressure are inherently linked to each other [ 9 , 11 , 23 , 24 ]. The variability of heart rate and blood pressure, along with direct increases in heart rate and systolic blood pressure, have been linked to nociception [ 9 , 22 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…The Surgical Pleth Index (SPI), a derived variable combining normalized pulse photoplethysmographic waveform amplitude (PPGA) and RR interval (RRI), monitors nociception by reflecting the changes in the balance of sympathetic and parasympathetic tone [ 8 , 9 , 23 ]. Extensive studies have evaluated the use of SPI in surgical anaesthesia, but published studies of use in critical care are lacking [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…The physiological stress responses to pain (tachycardia, hypertension, diaphoresis) can be blunted in ICU patients, mainly due to medication (sedatives, analgesics, muscle relaxants, blood pressure medication) [7,9]. The forehead muscles are less sensitive to neuromuscular blockade agents (NMBAs) [20], and frontal EMG reactivity to nociception should remain [20] even after classical signs (such as tachycardia and hypertension) are absent due to medication [7,[21][22][23].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Novel insights on association and reactivity of Bispectral Index, frontal electromyogram, and autonomic responses in nociception-sedation monitoring of critical care patients

et al. 2022

View full text Add to dashboard Cite

Background Assessing nociception and sedation in mechanically ventilated patients in the ICU is challenging, with few reliable methods available for continuous monitoring. Measurable cardiovascular and neurophysiological signals, such as frontal EEG, frontal EMG, heart rate, and blood pressure, have potential in sedation and nociception monitoring. The hypothesis of this explorative study is that derived variables from the aforementioned signals predict the level of sedation, as described by the Richmond Agitation-Sedation score (RASS), and respond to painful stimuli during critical care. Methods Thirty adult postoperative ICU patients on mechanical ventilation and receiving intravenous sedation, excluding patients with primary neurological disorders, head injury, or need for continuous neuromuscular blockage. Bispectral Index (BIS), EMG power (EMG), EMG-derived Responsiveness Index (RI), and averaged blood pressure variability (ARV) were tested against RASS measurements. The aforementioned variables together with blood pressure and Surgical Pleth Index (SPI) were explored before and after painful stimuli (for example bronchoscopy, or pleural puncture) at varying RASS levels, to test variable responsiveness. Results BIS, EMG, and RI predicted RASS levels with a prediction probability (PK) of 0.776 for BIS, 0.761 for EMG, and 0.763 for RI. In addition, BIS, EMG, and ARV demonstrated responsiveness to painful stimuli during deep sedation (RASS score ≤ -3). Conclusion Variables derived from EEG and EMG are associated with sedation levels, as described by the RASS score. Furthermore, these variables, along with ARV, react with consistency to painful stimuli during deep sedation (RASS -5 to -3), offering novel tools for nociception-sedation monitoring of mechanically ventilated ICU patients requiring deep sedation.

show abstract

Objective Assessment of Acute Pain

Abstract: Assessing acute pain in those unable to communicate is challenging yet essential. Objective assessment tools utilizing measures derived from autonomic changes alone or in combination appear to represent a potential solution to this difficult aspect of pain management.

Cited by 5 publications

References 40 publications

Does past/current pain change pain experience? Comparing self-reports and pupillary responses

Does past/current pain change pain experience? Comparing self-reports and pupillary responses

Chronic Pain and Chronic Opioid Use After Intensive Care Discharge – Is It Time to Change Practice?

Novel insights on association and reactivity of Bispectral Index, frontal electromyogram, and autonomic responses in nociception-sedation monitoring of critical care patients

Contact Info

Product

Resources

About