Name: a quantitative sensory testing paradigm to obtain measures of pain processing in patients undergoing breast cancer surgery
Uploaded: 2018-01-18T15:00:00.000+00:00
Duration: 7 min 14 s
Description: Watch this Scientific Journal Video about A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery at JoVE.com

我们感谢参加 "代表性成果" 部分的研究的病人。

这项议定书已在先前的随机对照试验中得到批准, 由荷兰的人类研究伦理委员会区域奈梅亨 (2004/239).
1. 测试准备
<ol><li>
知情同意:
	<ol>
<li>与患者一起复查知情同意表。</li>
		<li>回答病人可能对研究的任何问题。</li>
		<li>通过让病人签署知情同意书并亲自签署, 获得书面知情同意。</li>
	</ol>
</li>
	<li>
测试环境:
	<ol>
<li>在协议中执行所有的测量, 在一个刺激穷人和温度稳定环境 (〜21° c, 没有音乐, 没有被发现的窗口, 电话关闭)。 注意: 实验者的衣物必须尽可能中性, 即穿上实验室外衣, 在肘部下方赤裸, 不要佩戴首饰, 也不要佩戴香水。众所周知, 实验者相关因素可能对测量结果有影响。其中一些因素并非完全 standardizable (例如性), 但在准备测量的性能时应牢记这一点。</li>
		<li>在测量期间, 确保病人和研究员是唯一的人在房间里, 要求别人离开。</li>
		<li>将 "请勿打扰" 标志贴在门上, 以免在测量过程中受到干扰。</li>
		<li>与病人在床上的仰卧位进行所有的测试, 除了 CPM 测试, 这是与病人的坐姿。</li>
	</ol>
</li>
	<li>
测试站点:
	<ol>
<li>使用外科皮肤标记标记以下站点进行阈值测试: 在双肩 (C5 dermatome, 压力和电阈值) 下的大结节下的区域, 双边鱼际 (C6, dermatome, 压力), 双边髂嵴 (L1 dermatome, 压力和电), 双边在中期腋窝线乳癌手术切口的乳房高度或7厘米 (T4 dermatome, 压力和电阈值)。</li>
		<li>使用外科皮肤标记标记 CPM 测试站点:15 厘米以上的非显性身体部位的髌骨 (L3 dermatome, 压力)。</li>
		<li>使用外科皮肤标记标记一个测试运行站点, 例如, 在占主导地位的身体部位的髌骨上方15厘米。</li>
	</ol>
</li>
	<li>
电刺激配置:
	<ol>
<li>在每个电刺激试验场上的标记点的两侧涂抹两个自粘的皮肤电极。将电极放在它们的外径上, 这样它们就会在有标记的地方互相接触。</li>
		<li>设置 QST 刺激器提供强直刺激 (100 赫兹, 0.2 ms 方波)-图 1。将爬坡率设置为1毫安. 将初始电流设置为0毫安, 最大电流自动设置为50毫安, 以达到安全目的。</li>
	</ol>
</li>
</ol>2. 电痛阈值
<ol><li>
电力输送:
	<ol>
<li>使用 QST 刺激器。使用连接引线将自粘电极连接到刺激器。</li>
	</ol>
</li>
	<li>
视觉模拟量表 (VAS) 的测量:
	<ol>
<li>使用连接到 QST 刺激器的 vas 滑块获得 vas 分数。vas 滑块由一个表示 vas 的水平条上的移动拉杆组成的盒子构成。把滑块递给病人。</li>
		<li>向病人解释如何使用滑块: "控制单元有一个滑块。这个滑块可以移动, 以表明你如何体验刺激的规模, 不痛苦的最坏想象的痛苦.
</li>
	</ol>
</li>
	<li>测试运行:<ol>
<li>向患者解释电检测阈值 (EDT) 的过程: "我们将进行测试, 让您熟悉测量。刺激将开始时, 你按下按钮, 将逐渐增加, 并会立即停止后, 松开按钮。请按按钮, 当我告诉你这样做, 并放手时, 你有什么感觉. 注意: 所有指令都从手册中读取, 以帮助标准化。</li>
		<li>在测试运行站点上执行单个测试运行以演示过程。在测量表上记录结果-图 2。确保患者在执行测试时不能读取测量值。</li>
		<li>请病人用 VAS 滑块来说明他/她是如何经历刺激的, 并记下结果。</li>
		<li>解释的程序为电气疼痛阈值 (EPT) 病人: "我们将进行测试运行, 让您熟悉的测量。这项测试的目的是确定你的疼痛知觉响应电刺激。刺激将开始时, 你按下按钮, 将逐渐增加, 并会立即停止后, 松开按钮。当我告诉你这样做时, 请按下按钮, 当刺激变得痛苦的时候放手.
</li>
		<li>在测试站点上执行单个测试运行以演示过程。在测量表上记录结果。</li>
		<li>请病人用 VAS 滑块来说明他/她是如何经历刺激的, 并记下结果。</li>
	</ol>
</li>
	<li>
测量:
	<ol>
<li>使用2.3.1 的措辞, 再次向患者解释 EDT 的程序。</li>
		<li>测量在不同的研究地点的 EDT (首先 C5, 然后 T4, 然后 L1)。在每个测量站点执行 EDT 测量三次, 允许在测量之间至少15秒, 以避免饱和的影响。</li>
		<li>在每个站点的最后一次 EDT 测量后, 要求患者对 VAS 的相关疼痛进行评分。注意测量表上的电值和 VAS 分数。确保患者在执行测试时不能读取测量值。</li>
		<li>解释的程序, 以确定 EPT 再次使用的措辞从2.3.4。</li>
		<li>在不同的研究地点测量 EPT (先是 C5, 然后是 T4, 然后是 L1)。在每个测量站点执行 EPT 测量三次, 允许在测量之间至少15秒, 以避免饱和效果。</li>
		<li>在每个部位的最后一次 EPT 测量后, 要求患者对 VAS 的相关疼痛进行评分。</li>
		<li>注意测试测量表上的电值和 VAS 分数。确保患者在执行测试时不能读取测量值。</li>
	</ol>
</li>
</ol>3. 压力痛阈值
<ol><li>
交货压力:
	<ol>
<li>交付压力与压力 algometer 与 1.0 cm2探针在90°角度之下。通过手动调整施加的压力和显示器上的压力, 使用5米/秒的斜向速度。从 0 n 开始, 并申请最多 200 n 的安全目的。 注意: 小心不要让设备滑到皮肤上。为了防止 algometer 的打滑, 重要的是将探头垂直于皮肤, 并在缓慢增加压力的同时, 用双手支撑 algometer。研究人员应坚定地站出来, 以提供控制的压力增加。</li>
	</ol>
</li>
	<li>
测试运行:
	<ol>
<li>向病人解释程序: "我们将进行一个测试运行, 让您熟悉测量。这项测量的目的是确定你的感觉肌肉的压力疼痛。我会在你的肌肉上放一个压力测量装置, 并会逐渐增加压力。当压力感觉变得悸动、燃烧或痛苦时, 请告诉我 ' 现在 '.
</li>
		<li>在测试站点上执行单个测试运行。确保患者在执行测试时不能读取测量值。在测量表上记录结果。</li>
	</ol>
</li>
	<li>
测量:
	<ol>
<li>重复使用3.2.1 的措辞的病人的说明。</li>
		<li>将压力施加到不同的学习地点 (先是 C5, 然后 C6, 然后 T4, 然后 L1)。在每个测量站点上执行两次压力痛阈值 (PPT) 测量, 在测量之间至少允许15秒, 以避免饱和效果。</li>
		<li>在每个站点的最后一次 PPT 测量后, 要求患者对 VAS 的相关疼痛进行评分。</li>
		<li>注意测试压力值和测量表上的 VAS 分数。</li>
	</ol>
</li>
</ol>4. 适应的痛苦调制范例
<ol><li>
预适应测试刺激
	<ol>
<li>重复3.1.1。但使用 PPT 作为测试刺激。重复使用3.2.1 的措辞的病人的说明。</li>
		<li>在 CPM 测试站点上测量预调节 PPT (m。股骨直肌(L3) 在非显性侧, 15 厘米以上的髌骨)。要求患者对 VAS 滑块的相关疼痛进行评分。注意压力变得疼痛的值和相关的疼痛评分。</li>
		<li>向病人解释冰水的过程: "这是一个测试, 以获得关于你的身体处理不同的疼痛信号的方式在同一时间的信息。我会请你把手 submerse 在水桶里的冰水里。把你的手放在水里, 直到手腕和手指张开。请握住你的手在冰水中, 直到你不能再容忍它.
</li>
		<li>告诉病人在浸泡3分钟后将手从水中移开, 或在疼痛变得无法忍受的情况下更快。每10秒, 我就会要求你把疼痛率定在0到10的范围内, 其中0表示没有疼痛和10的痛苦。在你把你的手从冰水中取出后, 我们会再次测量你腿部的压力痛阈值, 类似于我们以前的做法.
</li>
	</ol>
</li>
	<li>
调节刺激:
	<ol>
<li>使用冷升压任务作为调节刺激。使用温度探头测量水温, 并注意温度 (目标温度介于1° c 和4° c 之间)。</li>
		<li>让病人在冰冷的水中浸泡支配的手。要求患者每10秒在 VAS 时对整个冷压任务的疼痛进行评分, 并记下结果。注意测量表上完成的浸泡时间 (最长为180秒, 平均为56±五十五年代8)。</li>
	</ol>
</li>
	<li>
确定测试刺激后的调节:
	<ol>
<li>在调节刺激后, 在 CPM 测试站点上测量 PPT。要求患者对 vas 的相关疼痛进行评分, 并将 PPT 和 vas 评分记录在纸上。</li>
	</ol>
</li>
</ol>5. 计算
<ol><li>
EPTs:
	<ol>
<li>计算 EDTs 和 EPTs 的每个测试位置的平均值。</li>
	</ol>
</li>
	<li>
PPTs:
	<ol>
<li>计算 PPTs 的每个测试位置的平均值。</li>
	</ol>
</li>
	<li>
cpm:
	<ol>
<li>通过在调节刺激10前后的 cpm 测试位置计算 PPT 中的相对变化 (%) 来确定 cpm 效果。 CPM = (ppt帖子– pptpre/ppt前) * 100 有条件的疼痛调制;PPT = 压力痛阈值。</li>
	</ol>
</li>
</ol>

<ol>
	<li>Macrae, W. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+post-surgical+pain:+10+years+on.">Chronic post-surgical pain: 10 years on.</a> Br J Anaesth. 101 (1), 77-86 (2008).</li><li>IASP Taxonomy Working Group. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Classification of Chronic Pain. , (2011).</li><li>Kehlet, H., Jensen, T. S., Woolf, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Persistent+postsurgical+pain:+risk+factors+and+prevention.">Persistent postsurgical pain: risk factors and prevention.</a> Lancet. 367 (9522), 1618-1625 (2006).</li><li>Steegers, M. A., Wolters, B., Evers, A. W., Strobbe, L., Wilder-Smith, O. 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作者没有利益冲突或任何财务利益的披露。

我们的方法, 量化压力疼痛阈值, 电子疼痛阈值, 和 CPM 可以成功地应用在临床的情况下, 因为它的短时间 (约20分钟)。我们先前已经表明, 术后早期获得的压力疼痛值可能对预测乳腺癌手术中长期随访的持续疼痛有价值8。在我们的研究中, 虽然电子疼痛阈值 CPM 并不能预测持续性疼痛, 但其他的则表明这些措施对于其他程序513可能有价值?...

慢性疼痛后手术, 持续后疼痛, 是一个重要的条件, 导致严重的症状负担和较低的生活质量1。持续的手术后疼痛仍未得到很好的理解, 但被广泛认为是手术后3月以上的疼痛2。这种情况是常见的, 其患病率的估计范围从10% 到50% 的所有后患者3。高危程序包括乳房手术4、开胸术的5、截肢6和疝气修复7。持续的后疼痛是相对难治的治疗, 从而引起了潜在的预防策略和治疗的兴趣。更好地了解预测和描述持续的术后疼痛, 将有助于确定可能需要额外治疗的患者的子集, 以优化其围手术期疼痛管理。
最近的研究表明, 在外科手术中, 疼痛阈值的异常变化可能对乳腺癌手术的长期持续疼痛的发展有预测价值8。其他人强调了条件性疼痛调制 (CPM) 效应在预测持续性术后疼痛方面的重要性, 例如, 在开胸手术后的持续疼痛5。CPM 是弥漫性有害抑制控制的行为关联, 一种生理现象, 来自外周 c 纤维的输入导致来自异位场的 c 纤维介导的所有传入刺激的脑干的弥漫性抑制9.CPM 效应是通过将阈值与有害刺激进行比较来衡量的, 这是在第二种不同刺激的应用前后测量的, 这被称为条件反射刺激10。
目前标准化的定量感官测试 (QST) 协议, 如德国研究网络神经病理性疼痛协议11是相当广泛, 可能不适合在外科病人的执行。本出版物的目的是详述一个简短和标准化的协议, 以获得疼痛阈值和 CPM 效果测量乳腺癌手术患者。本协议来自于我们大学与丹麦奥尔堡大学的合作协议12。

<table><tbody><tr><td>Bed</td><td>N/A</td><td>N/A</td><td>Any type of hospital bed or medical exam table</td></tr><tr><td>Desk</td><td>N/A</td><td>N/A</td><td>Any type of commercially available desk</td></tr><tr><td>Office chair</td><td>N/A</td><td>N/A</td><td>Any type of commercially available office chair</td></tr><tr><td>Force FPX 50 Pressure algometer</td><td>Wagner Instruments, Greenwich, CT, USA</td><td>N/A</td><td>Pressure algometer with a 1.0 cm2 circular tip to deliver pressure to perform pressure pain threshold measurements</td></tr><tr><td>Desktop computer</td><td>N/A</td><td>N/A</td><td>Any type of commercially available Windows computer to run QST-IV Stimulus Manager software on to control the QST-IV stimulator</td></tr><tr><td>QST-IV Stimulus Manager</td><td>Embedded Control BV, Ruurlo, the Netherlands</td><td>N/A</td><td>Software to control the settings of QST-IV electrical stimulator</td></tr><tr><td>QST-IV Electrical Stimulator</td><td>Embedded Control BV, Ruurlo, the Netherlands</td><td>N/A</td><td>Electrical quantitative sensory testing device with a patient operated switch. Device used to deliver electrical current to perform the electrical threshold measurements</td></tr><tr><td>VAS Slider</td><td>Embedded Control BV, Ruurlo, the Netherlands</td><td>N/A</td><td>The VAS slider consists of a box with a mobile lever on a horizontal bar that represents the VAS and is connected to the QST-IV.</td></tr><tr><td>Kendall H34SG 50 x 45 mm</td><td>Covidien, Mansfield, USA</td><td>N/A</td><td>Self-adhesive skin electrodes to apply to the measurement points on the skin to deliver electrical stimualtion</td></tr><tr><td>Crushed Ice</td><td>N/A</td><td>N/A</td><td>Ice generated by ice machine to cool water sufficiently for the cold pressor test</td></tr><tr><td>Bucket</td><td>N/A</td><td>N/A</td><td>Any type of commercially available 10 L bucket</td></tr><tr><td>Surgical skin marker</td><td>Covidien, Mansfield, USA</td><td>N/A</td><td>Any type of commercially available surgical skin marker</td></tr><tr><td>Stopwatch</td><td>N/A</td><td>N/A</td><td>Any type of commercially available stopwatch</td></tr><tr><td>Measurement form</td><td>N/A</td><td>N/A</td><td>Score form provided in the manuscript</td></tr><tr><td>Pencil</td><td>N/A</td><td>N/A</td><td>Any type of commercially available pencil</td></tr><tr><td>Thermometer</td><td>N/A</td><td>N/A</td><td>Thermometer to measure water temperature of ice water</td></tr><tr><td>Ruler</td><td>N/A</td><td>N/A</td><td>Any type of commercially available ruler</td></tr></tbody></table>

a quantitative sensory testing paradigm to obtain measures of pain processing in patients undergoing breast cancer surgery

慢性疼痛后手术, 持续后疼痛, 是一个重要的高度普遍的情况下, 造成重大症状负担和降低生活质量。持续的后疼痛是相对顽固的治疗, 因此产生了很高的需要预防策略和治疗。因此, 确定患持续性疼痛的风险患者是一个积极进行的研究领域。最近有人证实, 中心疼痛处理的围手术期中断可能能够预测乳腺癌患者长期随访的持续后疼痛。本报告的目的是提出一个简短的协议, 以获得不同的刺激在多个地点的疼痛阈值, 并在乳腺癌患者的内源性镇痛措施。我们在临床上成功地运用了这一方法, 并从临床研究中得到了一些有代表性的结果。

在以前发表的临床试验中, 妇女 (N = 94) 接受乳腺癌手术, 我们使用本报告中描述的协议8测量了电和压痛阈值以及 CPM。我们在手术后的一年中, 在不同的时间点执行了测试范例。我们发现女性在乳腺癌手术后12月内持续后疼痛, 定义为 > 30 毫米的 VAS, 在手术后早期和晚期都表现出较低的压力痛阈值。图 3详细介绍了在手术后早期 ...

Watch this Scientific Journal Video about A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery at JoVE.com

A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery

持续的后疼痛可能与疼痛处理的变化有关。通过评估对标准化刺激的反应疼痛, 可以阐明疼痛处理的变化。我们提出的方法, 以获得不同刺激的疼痛阈值和一项措施内源性镇痛的病人进行乳腺癌手术。

一种定量感官检测方法在乳腺癌手术患者疼痛处理中的研究

Chronic pain following surgery, persistent postsurgical pain, is an important highly prevalent condition contributing to significant symptom burden and ...

a-quantitative-sensory-testing-paradigm-to-obtain-measures-pain

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

9.2K 次观看.  Radboud University Medical Center. 持续的后疼痛可能与疼痛处理的变化有关。通过评估对标准化刺激的反应疼痛, 可以阐明疼痛处理的变化。我们提出的方法, 以获得不同刺激的疼痛阈值和一项措施内源性镇痛的病人进行乳腺癌手术。

视频: A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery

An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)

Many women undergo cesarean delivery without problems, however some experience significant pain after cesarean section. Pain is associated with negative short-term and long-term effects on the mother. Prior to women undergoing surgery, can we predict who is at risk for developing significant postoperative pain and potentially prevent or minimize its negative consequences? These are the fundamental questions that a team from the University of Washington, Stanford University, the Catholic University in Brussels, Belgium, Santa Joana Women's Hospital in S&atilde;o Paulo, Brazil, and Rambam Medical Center in Israel is currently evaluating in an international research collaboration. The ultimate goal of this project is to provide optimal pain relief during and after cesarean section by offering individualized anesthetic care to women who appear to be more 'susceptible' to pain after surgery.
A significant number of women experience moderate or severe acute post-partum pain after vaginal and cesarean deliveries. 1 Furthermore, 10-15% of women suffer chronic persistent pain after cesarean section. 2 With constant increase in cesarean rates in the US 3 and the already high rate in Brazil, this is bound to create a significant public health problem. When questioning women's fears and expectations from cesarean section, pain during and after it is their greatest concern. 4 Individual variability in severity of pain after vaginal or operative delivery is influenced by multiple factors including sensitivity to pain, psychological factors, age, and genetics. The unique birth experience leads to unpredictable requirements for analgesics, from 'none at all' to 'very high' doses of pain medication. Pain after cesarean section is an excellent model to study post-operative pain because it is performed on otherwise young and healthy women. Therefore, it is recommended to attenuate the pain during the acute phase because this may lead to chronic pain disorders. The impact of developing persistent pain is immense, since it may impair not only the ability of women to care for their child in the immediate postpartum period, but also their own well being for a long period of time.
In a series of projects, an international research network is currently investigating the effect of pregnancy on pain modulation and ways to predict who will suffer acute severe pain and potentially chronic pain, by using simple pain tests and questionnaires in combination with genetic analysis. A relatively recent approach to investigate pain modulation is via the psychophysical measure of Diffuse Noxious Inhibitory Control (DNIC). This pain-modulating process is the neurophysiological basis for the well-known phenomenon of 'pain inhibits pain' from remote areas of the body. The DNIC paradigm has evolved recently into a clinical tool and simple test and has been shown to be a predictor of post-operative pain.5 Since pregnancy is associated with decreased pain sensitivity and/or enhanced processes of pain modulation, using tests that investigate pain modulation should provide a better understanding of the pathways involved with pregnancy-induced analgesia and may help predict pain outcomes during labor and delivery. For those women delivering by cesarean section, a DNIC test performed prior to surgery along with psychosocial questionnaires and genetic tests should enable one to identify women prone to suffer severe post-cesarean pain and persistent pain. These clinical tests should allow anesthesiologists to offer not only personalized medicine to women with the promise to improve well-being and satisfaction, but also a reduction in the overall cost of perioperative and long term care due to pain and suffering. On a larger scale, these tests that explore pain modulation may become bedside screening tests to predict the development of pain disorders following surgery.

An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP

Diffuse noxious inhibitory control, temporal summation and wound hyperalgesia testing are demonstrated in the obstetric patient. These tests evaluate inhibitory and excitatory mechanisms of pain processing and are here utilized to evaluate endogenous analgesia at different time-points during pregnancy and the peripartum period to help reveal individual s risk for persistent pain.

用于预测手术后的疼痛的实验范式（PPOP）

Many women undergo cesarean delivery without problems, however some experience significant pain after cesarean section. Pain is associated with negative ...

科研

医学

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through implanted electrodes. Deep brain stimulation was first implemented as a therapeutic modality by Benabid et al. in the late 1980s, when he used this technique to stimulate the ventral intermediate nucleus of the thalamus for the treatment of tremor 1. Currently, the procedure is used to treat patients who fail to respond adequately to medical management for diseases such as Parkinson's, dystonia, and essential tremor. The efficacy of this procedure for the treatment of Parkinson's disease has been demonstrated in well-powered, randomized controlled trials 2. Presently, the U.S. Food and Drug Administration has approved DBS as a treatment for patients with medically refractory essential tremor, Parkinson's disease, and dystonia. Additionally, DBS is currently being evaluated for the treatment of other psychiatric and neurological disorders, such as obsessive compulsive disorder, major depressive disorder, and epilepsy. 
DBS has not only been shown to help people by improving their quality of life, it also provides researchers with the unique opportunity to study and understand the human brain. Microelectrode recordings are routinely performed during DBS surgery in order to enhance the precision of anatomical targeting. Firing patterns of individual neurons can therefore be recorded while the subject performs a behavioral task. Early studies using these data focused on descriptive aspects, including firing and burst rates, and frequency modulation 3. More recent studies have focused on cognitive aspects of behavior in relation to neuronal activity 4,5. This article will provide a description of the intra-operative methods used to perform behavioral tasks and record neuronal data with awake patients during DBS cases. Our exposition of the process of acquiring electrophysiological data will illuminate the current scope and limitations of intra-operative human experiments.

Deep brain stimulation surgery offers a unique opportunity to examine information encoding in the awake human brain. This article will describe intra-operative methods used to perform cognitive and behavioral tasks while simultaneously acquiring physiological data such as EMG, single-unit neuronal activity and/or local field potentials.

在接受深部脑刺激手术术中唤醒人类行为任务

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through ...

Quantitative Autonomic Testing

Disorders associated with dysfunction of autonomic nervous system are quite common yet frequently unrecognized. Quantitative autonomic testing can be invaluable tool for evaluation of these disorders, both in clinic and research. There are number of autonomic tests, however, only few were validated clinically or are quantitative. Here, fully quantitative and clinically validated protocol for testing of autonomic functions is presented. As a bare minimum the clinical autonomic laboratory should have a tilt table, ECG monitor, continuous noninvasive blood pressure monitor, respiratory monitor and a mean for evaluation of sudomotor domain. The software for recording and evaluation of autonomic tests is critical for correct evaluation of data. The presented protocol evaluates 3 major autonomic domains: cardiovagal, adrenergic and sudomotor. The tests include deep breathing, Valsalva maneuver, head-up tilt, and quantitative sudomotor axon test (QSART). The severity and distribution of dysautonomia is quantitated using Composite Autonomic Severity Scores (CASS). Detailed protocol is provided highlighting essential aspects of testing with emphasis on proper data acquisition, obtaining the relevant parameters and unbiased evaluation of autonomic signals. The normative data and CASS algorithm for interpretation of results are provided as well.

Standardized, comprehensive and fully quantitative testing of autonomic functions is described. The autonomic tests consist of evaluation of all three major autonomic domains including cardiovagal, adrenergic and sudomotor. The severity and distribution of dysautonomia is quantitated using Composite Autonomic Severity Scores.

定量自主测试

Disorders associated with dysfunction of autonomic nervous system are quite common yet frequently unrecognized. Quantitative autonomic testing can be ...

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients 

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, and persistent nerve and muscle impairments after hospital discharge.1-6 Using an explicit protocol with a structured approach to training and quality assurance of research staff, manual muscle testing (MMT) is a highly reliable method for assessing strength, using a standardized clinical examination, for patients following ARDS, and can be completed with mechanically ventilated patients who can tolerate sitting upright in bed and are able to follow two-step commands. 7, 8 
This video demonstrates a protocol for MMT, which has been taught to &ge;43 research staff who have performed &gt;800 assessments on &gt;280 ARDS survivors. Modifications for the bedridden patient are included. Each muscle is tested with specific techniques for positioning, stabilization, resistance, and palpation for each score of the 6-point ordinal Medical Research Council scale.7,9-11 Three upper and three lower extremity muscles are graded in this protocol: shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion. These muscles were chosen based on the standard approach for evaluating patients for ICU-acquired weakness used in prior publications. 1,2.

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Survivors of acute respiratory distress syndrome (ARDS) and critical illness frequently develop long-lasting muscle weakness. Manual muscle testing (MMT) is a standardized clinical examination commonly used to measure strength of peripheral skeletal muscle groups. This video demonstrates MMT using the 6-point Medical Research Council scale.

危重病人中的应用手册肌力测试：下肢肌力测量方法

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, ...

Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery

Human pain models are useful in the assessing the analgesic effect of drugs, providing information about a drug&#39;s pharmacology and identify potentially suitable therapeutic populations. The need to use a comprehensive battery of pain models is highlighted by studies whereby only a single pain model, thought to relate to the clinical situation, demonstrates lack of efficacy. No single experimental model can mimic the complex nature of clinical pain. The integrated, multi-modal pain task&#160;battery presented here encompasses the electrical stimulation task, pressure stimulation task, cold pressor task, the UVB inflammatory model which includes a thermal task and a paradigm for inhibitory conditioned pain modulation. These human pain models have been tested for predicative validity and reliability both in their own right and in combination, and can be used repeatedly, quickly, in short succession, with minimum burden for the subject and with a modest quantity of equipment. This allows a drug to be fully characterized and profiled for analgesic effect which is especially useful for drugs with a novel or untested mechanism of action.

Human pain models are valuable tools used to assess the analgesic potential of novel compounds and predict their clinical efficacy, especially when used in an integrated manner. Although implementation of these models is complex, with proper execution, the pain models described in this protocol can provide predictive and reliable results.

确定疼痛的检测和容忍阈值使用集成的，多模式疼痛任务电池

Human pain models are useful in the assessing the analgesic effect of drugs, providing information about a drug&#39;s pharmacology and identify ...

行为学

A Protocol of Manual Tests to Measure Sensation and Pain in Humans

Numerous qualitative and quantitative techniques can be used to test sensory nerves and pain in both research and clinical settings. The current study demonstrates a quantitative sensory testing protocol using techniques to measure tactile sensation and pain threshold for pressure and heat using portable and easily accessed equipment. These techniques and equipment are ideal for new laboratories and clinics where cost is a concern or a limiting factor. We demonstrate measurement techniques for the following: cutaneous mechanical sensitivity on the arms and legs (von-Frey filaments), radiant and contact heat sensitivity (with both threshold and qualitative assessments using the Visual Analog Scale (VAS)), and mechanical pressure sensitivity (algometer, with both threshold and the VAS). The techniques and equipment described and demonstrated here can be easily purchased, stored, and transported by most clinics and research laboratories around the world. A limitation of this approach is a lack of automation or computer control. Thus, these processes can be more labor intensive in terms of personnel training and data recording than the more sophisticated equipment. We provide a set of reliability data for the demonstrated techniques. From our description, a new laboratory should be able to set up and run these tests and to develop their own internal reliability data.

The goal of this procedure is to demonstrate a battery of quantitative techniques for sensory and pain measurement in humans. The equipment and techniques described are commonly found in pain clinics or are easy to obtain.

手动测试的协议来衡量感觉和疼痛人类

Numerous qualitative and quantitative techniques can be used to test sensory nerves and pain in both research and clinical settings. The current study ...

Multi-Modal Signals for Analyzing Pain Responses to Thermal and Electrical Stimuli

The assessment of pain relies mostly on methods that require a person to communicate. However, for people with cognitive and verbal impairments, existing methods are not sufficient as they lack reliability and validity. To approach this problem, recent research focuses on an objective pain assessment facilitated by parameters of responses derived from physiology, and video and audio signals. To develop reliable automated pain recognition systems, efforts have been made in creating multimodal databases in order to analyze pain and detect valid pain patterns. While the results are promising, they only focus on discriminating pain or pain intensities versus no pain. In order to advance this, research should also consider the quality and duration of pain as they provide additional valuable information for more advanced pain management. To complement existing databases and the analysis of pain regarding quality and length, this paper proposes a psychophysiological experiment to elicit, measure, and collect valid pain reactions. Participants are subjected to painful stimuli that differ in intensity (low, medium, and high), duration (5 s / 1 min), and modality (heat / electric pain) while audio, video (e.g., facial expressions, body gestures, facial skin temperature), and physiological signals (e.g., electrocardiogram [ECG], skin conductance level [SCL], facial electromyography [EMG], and EMG of M. trapezius) are being recorded. The study consists of a calibration phase to determine a subject&#8217;s individual pain range (from low to intolerable pain) and a stimulation phase in which pain stimuli, depending on the calibrated range, are applied. The obtained data may allow refining, improving, and evaluating automated recognition systems in terms of an objective pain assessment. For further development of such systems and to investigate pain reactions in more detail, additional pain modalities such as pressure, chemical, or cold pain should be included in future studies. Recorded data of this study will be released as the &#8220;X-ITE Pain Database&#8221;.

This article focuses on the experimental elicitation of pain through heat (thermal) and electrical stimulation while recording physiological, visual, and paralinguistic responses. It aims at collecting valid multimodal data for analyzing pain based on its intensity, quality, and duration.&#160;

分析疼痛对热和电刺激反应的多模态信号

The assessment of pain relies mostly on methods that require a person to communicate. However, for people with cognitive and verbal impairments, existing ...

Dynamic Quantitative Sensory Testing to Characterize Central Pain Processing

Central facilitation and modulation of incoming nociceptive signals play an important role in the perception of pain. Disruption in central pain processing is present in many chronic pain conditions and can influence responses to specific therapies. Thus, the ability to precisely describe the state of central pain processing has profound clinical significance in both prognosis and prediction. Because it is not practical to record neuronal firings directly in the human spinal cord, surrogate behavior tests become an important tool to assess the state of central pain processing. Dynamic QST is one such test, and can probe both the ascending facilitation and descending modulation of incoming nociceptive signals via TS and CPM, respectively. Due to the large between-individual variability in the sensitivity to noxious signals, standardized TS and CPM tests may not yield any meaningful data in up to 50% of the population due to floor or ceiling effects. We present methodologies to individualize TS and CPM so we can capture these measures in a broader range of individuals than previously possible. We have used these methods successfully in several studies at the lab, and data from one ongoing study will be presented to demonstrate feasibility and potential applications of the methods.

By assessing pain in response to repetitive or different types of standardized stimuli, dynamic quantitative sensory testing (QST) can reveal changes in the central processing of pain. We present methods to optimize and individualize two dynamic QST measures: temporal summation (TS) and conditioned pain modulation (CPM).

动态定量感觉测试表征中央疼痛处理

Central facilitation and modulation of incoming nociceptive signals play an important role in the perception of pain. Disruption in central pain ...

神经科学

Assessment of Sensory Thresholds in Dogs Using Mechanical and Hot Thermal Quantitative Sensory Testing

Quantitative sensory testing (QST) is used to evaluate the function of the somatosensory system in dogs by assessing the response to applied mechanical and thermal stimuli. QST is used to determine normal dogs&#39; sensory thresholds and evaluate alterations in peripheral and central sensory pathways caused by various disease states, including osteoarthritis, spinal cord injury, and cranial cruciate ligament rupture. Mechanical sensory thresholds are measured by electronic von Frey anesthesiometers and pressure algometers. They are determined as the force at which the dog exhibits a response indicating conscious stimulus perception. Hot thermal sensory thresholds are the latency to respond to a fixed or ramped temperature stimulus applied by a contact thermode.
Following a consistent protocol for performing QST and paying attention to details of the testing environment, procedure, and individual study subjects are critical for obtaining accurate QST results for dogs. Protocols for the standardized collection of QST data in dogs have not been described in detail. QST should be performed in a quiet, distraction-free environment that is comfortable for the dog, the QST operator, and the handler. Ensuring that the dog is calm, relaxed, and properly positioned for each measurement helps produce reliable, consistent responses to the stimuli and makes the testing process more manageable. The QST operator and handler should be familiar and comfortable with handling dogs and interpreting dogs&#39; behavioral responses to potentially painful stimuli to determine the endpoint of testing, reduce stress, and maintain safety during the testing process.

This work describes a standard protocol for mechanical and hot thermal quantitative sensory testing to evaluate the somatosensory system in dogs. Sensory thresholds are measured using an electronic von Frey anesthesiometer, pressure algometer, and hot contact thermode.

使用机械和热热定量感官测试评估狗的感官阈值

Quantitative sensory testing (QST) is used to evaluate the function of the somatosensory system in dogs by assessing the response to applied mechanical ...

一种从疼痛体图评估疼痛的新方法

Quantifying Pain Location and Intensity with Multimodal Pain Body Diagrams

To quantify an individual&#39;s subjective pain severity, standardized pain rating scales such as the numeric rating scale (NRS), visual analog scale (VAS), or McGill pain questionnaire (MPQ) are commonly used to assess pain on a numerical scale. However, these scales are often biased and fail to capture the complexity of pain experiences. In contrast, clinical practice often requires patients to report areas of pain by drawing on a body diagram, which is an effective but qualitative tool. The method presented here extracts quantifiable metrics from pain body diagrams (PBDs) which are validated against the NRS, VAS, and MPQ pain scales. By using a novel pressure-hue transformation on a digital tablet, different drawing pressures applied with a digital stylus can be represented as different hues on a PBD. This produces a visually intuitive diagram of hues ranging from green to blue to red, representing mild to moderate to most painful regions, respectively. To quantify each PBD, novel pain metrics were defined: (1) PBD mean intensity, which equals the sum of each pixel&#39;s hue value divided by the number of colored pixels, (2) PBD coverage, which equals the number of colored pixels divided by the total number of pixels on the body, and (3) PBD sum intensity, which equals the sum of all pixels&#39; hue values. Using correlation and information theory analyses, these PBD metrics were shown to have high concordance with standardized pain metrics, including NRS, VAS and MPQ. In conclusion, PBDs can provide novel spatial and quantitative information that can be repeatedly measured and tracked over time to comprehensively characterize a participant&#39;s pain experience.

作者聚焦：量化疼痛体验 – 使用疼痛体图的说明性方法 

Current pain scales used to quantify pain severity, such as visual analog scales, fail to capture the complexity of subjective pain experiences. Pain body diagrams are qualitative but may be more informative. The goal of this method is to extract quantitative metrics from pain body diagrams using novel pressure-hue transformation.

使用多模态疼痛身体图量化疼痛位置和强度

To quantify an individual&#39;s subjective pain severity, standardized pain rating scales such as the numeric rating scale (NRS), visual analog scale ...