Objective Pain Measures in Awake Sedated, Anesthetized Individuals with NIRS

使用 NIRS 对清醒、镇静、麻醉个体进行客观疼痛测量

• 批准号: 8787757
• 负责人: DAVID BORSOOK
• 金额: $ 51.23万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8787757
• 关键词: Absence of pain sensation; Acute Pain; Affect; Amnesia; Analgesics; Anesthesia procedures; Awareness; Biological Markers; Brain; Brain region; Cerebral cortex; Characteristics; Clinical; Clinical Research; Colonoscopy; Conscious; Conscious Sedation; Couples; Effectiveness; Electric Stimulation; Environment; Esthesia; Event; Feeling; Fiber Optics; Functional Magnetic Resonance Imaging; Future; General Anesthesia; Head; Health; Hypnosis; Incidence; Individual; Intravenous Anesthesia; Lead; Measures; Monitor; Morphine; Morphologic artifacts; Motion; Motor; Motor Cortex; Movement; Near-Infrared Spectroscopy; Neural Inhibition; Nociception; Numbness; Operating Rooms; Operative Surgical Procedures; Opioid; Outcome; Pain; Pain Measurement; Pain management; Patients; Physicians; Physiological; Positioning Attribute; Post-Traumatic Stress Disorders; Postoperative Period; Prefrontal Cortex; Prevalence; Procedures; Process; Sedation procedure; Sensory; Signal Transduction; Somatosensory Cortex; Specialist; Stimulus; Surgical incisions; System; Technology; Testing; Titrations; Translating; Translations; Unconscious State; United States; Venous; Woman; awake; chronic pain; clinically relevant; cohort; healthy volunteer; hemodynamics; imaging modality; interest; men; novel; operation; painful neuropathy; relating to nervous system; response; sensor; signal processing; somatosensory; success; tool

DESCRIPTION (provided by applicant): Over 23 million surgeries are performed each year in the United States. Currently there are no objective measures for pain during surgery. Over the past few years we have developed the use of Near Infrared Spectroscopy (NIRS) to provide an objective measure of pain sensation. Near infrared spectroscopy (NIRS) systems are simple and portable, and easily applicable in the operating room, enabling the physician to measure activity in specific brain regions involved in the sensation of pain (primary somatosensory cortex, SI) or motor planning/escape (supplementary motor cortex, SMA). We have identified a specific pain signal from the supplementary motor and prefrontal cortices. We now propose to advance the NIRS technology to make the measure of this pain biomarker more robust for the clinical environment, validate the measure in controlled clinically relevant conditions, and then demonstrate clinical utility for monitoring pain sensation in an operating room environment. Our hypothesis is that objective measures by NIRS during anesthesia of neural activity in the primary somatosensory and prefrontal cortices in response to an intermittent pain stimulus will reflect the effectiveness of analgesic blockade while under anesthesia. Three specific aims have been generated to test this hypothesis: (1) To advance NIRS technology for the operating room environment by advancing signal processing to filter systemic interference and dynamically estimate the pain biomarker; (2) To validate objective measure of pain by evaluating analgesic effects of an opioid (morphine) in healthy men and women; and to test for pain measures under sedation in otherwise healthy men and women undergoing colonoscopy; and (3) To translate these measures to patients undergoing inhalational anesthesia or total intravenous anesthesia. Successful completion of the aims will lead towards a new tool for the anesthesiologist to optimize management of the patient to reduce the incidence of peri-operative pain-related sequelae. We have put together an interdisciplinary team (NIRS specialists and pain specialists and physicians) to undertake and complete the proposed studies.

描述（由申请人提供）：美国每年进行超过 2300 万例手术。目前尚无针对手术期间疼痛的客观措施。在过去的几年中，我们开发了近红外光谱 (NIRS) 的使用来提供疼痛感觉的客观测量。近红外光谱 (NIRS) 系统简单便携，易于在手术室应用，使医生能够测量涉及疼痛感（初级体感皮层，SI）或运动计划/逃避（补充）的特定大脑区域的活动运动皮层，SMA）。我们已经识别出来自辅助运动皮质和前额叶皮质的特定疼痛信号。我们现在建议推进 NIRS 技术，使这种疼痛生物标志物的测量在临床环境中更加稳健，在受控的临床相关条件下验证该测量，然后证明在手术室环境中监测疼痛感觉的临床实用性。我们的假设是，在麻醉期间通过 NIRS 对初级体感和前额叶皮层响应间歇性疼痛刺激的神经活动进行客观测量，将反映麻醉期间镇痛封锁的有效性。为了检验这一假设，我们提出了三个具体目标：（1）通过推进信号处理来过滤系统干扰并动态估计疼痛生物标志物，以推进手术室环境的 NIRS 技术； (2) 通过评估阿片类药物（吗啡）对健康男性和女性的镇痛效果来验证疼痛的客观测量；并测试接受结肠镜检查的其他健康男性和女性在镇静状态下的疼痛测量； (3) 将这些措施应用于接受吸入麻醉或全静脉麻醉的患者。成功完成这些目标将为麻醉师提供一种新工具，以优化患者管理，减少围手术期疼痛相关后遗症的发生率。我们组建了一个跨学科团队（NIRS 专家、疼痛专家和医生）来开展并完成拟议的研究。