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）：在美国，每年进行超过2300万次手术。目前，手术期间没有疼痛的客观措施。在过去的几年中，我们开发了近红外光谱法（NIR）的使用，以提供疼痛感觉的客观度量。近红外光谱（NIRS）系统简单易移，易于适用于手术室，使医生能够测量参与疼痛感觉的特定大脑区域的活动（原发性体感皮层，SI）或运动计划/逃生（补充运动皮层，SMA，SMA）。我们已经从补充运动和前额叶皮层中确定了特定的疼痛信号。现在，我们建议推进NIRS技术，以使对临床环境的疼痛生物标志物的量度更强，验证在受控临床相关条件下的测量，然后证明在手术室环境中监测疼痛感的临床实用性。我们的假设是，响应间歇性疼痛刺激的原发性体感和前额叶皮层的神经活动麻醉期间的客观措施将反映在麻醉下时镇痛阻塞的有效性。已经生成了三个特定的目标来检验这一假设：（1）通过推进信号处理以过滤系统性干扰并动态估计疼痛生物标志物，以推动手术室环境的NIRS技术； （2）通过评估阿片类药物（吗啡）对健康的男性和女性的镇痛作用来验证疼痛的客观测量；并测试接受结肠镜检查的健康男性和女性镇静下的疼痛措施； （3）将这些措施转化为正在接受吸入麻醉或总麻醉的患者。成功完成目标将为麻醉师提供一种新工具，以优化患者的管理，以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，痛苦专家和医生），以进行和完成拟议的研究。