Translation of random painful stimuli into numerical responses in fibromyalgia and perioperative patients

Oudejans, Linda; M, van Velzen; Olofsen, Erik; Beun, R; Dahan, Albert

doi:10.1097/j.pain.0000000000000338

Cited by 13 publications

(9 citation statements)

References 22 publications

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“…5). As discussed previously, 11 different pain models activate different pain pathways with differences in central processing.…”

Section: Discussionmentioning

confidence: 83%

“…After obtaining Pth and Ptol values for electrical and heat tests, we constructed a linear distribution of 8 interpolated currents and temperatures in between Pth and Ptol, corresponding with estimated NRS scores of 2 to 9. 11,12 We then randomly applied stimuli to the subjects corresponding with NRS values 1, 4, 6 and 9 with at least 1-min intervals between stimuli. First one complete set of stimuli (heat or electrical) was applied and followed by a second set after a 30-min pause, the order of which was random.…”

Section: Stimulation Protocolmentioning

confidence: 99%

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Use of dynamic light scattering for assessing acute pain

Broens

Bar-Noam

Fine

et al. 2019

Novel Biophotonics Techniques and Applications V

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Currently there is no accurate objective measure for monitoring pain during the state of drug-induced unconsciousness (such as during surgical anesthesia). Moreover, the absence of an objective measure for detecting pain hampers the physician's ability to provide an optimal dose of analgesics. We have developed a novel method for detecting pain by quantifying skin blood flow dynamics using a miniaturized dynamic light scattering (mDLS) sensor placed on the skin. Healthy awake volunteers were studied with mDLS sensors placed on both index fingers while being subjected to a series of cutaneous painful stimuli (electric shock and heat), randomly applied in a range between the subjects' pain threshold and tolerance. Power spectrum analysis of the recorded signal was performed with a focus on two frequency bands, representing relative blood flow of non-pulsatile vessels and larger pulsatile arterioles. Relative blood flow of pulsatile vessels decreased while flow of non-pulsatile vessels increased in response to painful stimulation, with a high correlation between the responses obtained on the right and left index fingers. The changes in hemodynamics that occur during painful stimulation suggest a redistribution of blood flow between pulsatile and non-pulsatile vessels, probably related to central activation of the sympathetic system combined with local dynamic autoregulatory responses. Thus, optical parameters of skin blood flow can detect nociceptive stimuli and consequently can serve as objective biomarkers of pain.

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“…5). As discussed previously, 11 different pain models activate different pain pathways with differences in central processing.…”

Section: Discussionmentioning

confidence: 83%

Section: Stimulation Protocolmentioning

confidence: 99%

Use of dynamic light scattering for assessing acute pain

Broens

Bar-Noam

Fine

et al. 2019

Novel Biophotonics Techniques and Applications V

Self Cite

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“…In real life rapid and loose up-and-down titrations are allowed aimed at optimizing effect with as few as possible side effects and often combined with comedication; (4) Pain intensity scores are often not well understood by patients and additionally may not capture the beneficial effects of ketamine on mood, cognition, and quality of life. Linear metric scores on a 100 mm scale or numerical ratings poorly represent the actual perceived pain, particularly under conditions of chronic pain and cognitive impairment [57,58]. Moreover, ketamine may affect cognition and consequently more qualitative than quantitative scoring systems are likely required; (5) Placebo controls may cause a bias in study outcome either due to an inflated placebo effect or due to the fact that well-informed clinical-trial participants that experience absence of side effects may decide to terminate their participation in the study [59,60]; and finally, (6) In real life, patients with severe and progressive neuropathic pain often have other symptoms or complaints that restrict their ability to be included in the trial.…”

Section: Expert Opinionmentioning

confidence: 99%

Pharmacokinetic and pharmacodynamic considerations for NMDA-receptor antagonist ketamine in the treatment of chronic neuropathic pain: an update of the most recent literature

Kamp

Olofsen

et al. 2019

Expert Opinion on Drug Metabolism & Toxicology

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Introduction: Chronic neuropathic pain (NP) is an incapacitating illness caused by a lesion of the somatosensory nervous system and is associated with several diseases or syndromes. Since current treatment options lack adequate efficacy in the majority of patients, ketamine is often administered to treat refractory NP. Areas covered: This review gives an overview of new ketamine pharmacokinetic data including data on intranasal and inhaled ketamine. The outcome of seven systematic reviews and meta-analyses, published since 2012, on ketamine efficacy in NP is discussed. The reader will additionally get an understanding of ketamine's complex metabolism with emphasis on the metabolite hydroxynorketamine. Expert opinion: Proof of sustained, large effects of ketamine in the treatment of NP from randomized controlled clinical trials is lacking, although we cannot exclude selective ketamine efficacy in patients with central sensitization, opioid-induced hyperalgesia or opioid tolerance. Interestingly, data from observational trials and case series do suggest the efficacy of ketamine in producing effective pain relief in NP with positive patient-related outcome measures. Additional randomized trials in often illdefined groups of chronic pain patients are not useful and we suggest to conduct future studies in NP patients with central sensitization and/or with opioid refractory severe NP.

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“…Additionally, patients and caregivers interpret pain intensity scores differently [3]. A recent study showed that some patients are not able to use the NRS reliably [31]. Patients may choose not to take more analgesics because they interpret their pain as “bearable” [12, 32].…”

Section: Discussionmentioning

confidence: 99%

Moving beyond pain scores: Multidimensional pain assessment is essential for adequate pain management after surgery

et al. 2017

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BackgroundClinical experience teaches us that patients are willing to accept postoperative pain, despite high pain intensity scores. Nevertheless, relationships between pain scores and other methods of pain assessment, e.g. acceptability of pain or its interference with physical functioning, are not fully established. Our aims were to examine these relationships.MethodsA cross-sectional study was conducted on patients who underwent major surgery between January 2008 and August 2013. Using logistic regression, we quantified the relationships between movement-evoked pain scores on the numerical rating scale (NRS-MEP) and three dichotomous dependent variables: patient’s opinion on acceptability of pain (PO: acceptable or unacceptable pain); nurses’ observation of patient’s performance of necessary activities to expedite recovery (NO: good or bad performance); a compound measure judging the presence of the clinically desirable situation of acceptable pain associated with good patients’ performance (PONO: present or not). Using Receiver Operating Characteristics (ROC) analysis, NRS cut-off points were determined such that they best discriminate between patients having one versus the other outcome for PO, NO and PONO.Results15,394 assessments were obtained in 9,082 patients in the first three postoperative days. Nine percent of the patients had unacceptable pain while having an NRS-MEP of 0–4. An estimated 47% (95%CI = 45%-49%) of patients with an NRS-MEP of 7 described their pain as acceptable on day one. Moreover, 33% (31%-35%) performed all required physical activities, and 22% (21%-24%) combined acceptable pain with appropriate movement. NRS cut-off points for PO, NO and PONO were five, four and four, respectively, but had insufficient discriminatory power.ConclusionsOur results suggest pain management should be guided by the many dimensions of the patient’s pain experience, not solely by NRS cut-off points. Future research should evaluate the impact of such multidimensional pain assessment on patients’ functional outcome.

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Translation of random painful stimuli into numerical responses in fibromyalgia and perioperative patients

Cited by 13 publications

References 22 publications

Use of dynamic light scattering for assessing acute pain

Use of dynamic light scattering for assessing acute pain

Pharmacokinetic and pharmacodynamic considerations for NMDA-receptor antagonist ketamine in the treatment of chronic neuropathic pain: an update of the most recent literature

Moving beyond pain scores: Multidimensional pain assessment is essential for adequate pain management after surgery

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