Analysis of acute pain scores and skin conductance measurements in infants

Dalal, Priti G.; Doheny, Kim K.; Klick, Lisa; Britcher, Stella; Rebstock, Sarah; Bezinover, Dmitri; Palmer, Charles; Berlin, Cheston M.; Postuła, Marek; Kong, Lan; Janicki, Piotr K.

doi:10.1016/j.earlhumdev.2012.09.008

Cited by 19 publications

(14 citation statements)

References 33 publications

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“…Our findings are consistent with other studies which have shown mean of peaks and peaks/seconds increase significantly with stimuli such as heel lance, noise and other stimuli . Dalal et al reported a similar finding when SC was applied in postoperative paediatric (6–12 months of age) patients recovering from anaesthesia. In this study, the mean of peaks and basal levels was more sensitive measures of autonomic arousal than peaks/seconds in the postoperative period in paediatric patients .…”

Section: Discussionsupporting

confidence: 93%

Skin conductance at baseline and postheel lance reflects sympathetic activation in neonatal opiate withdrawal

et al. 2015

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Aim Skin conductance (SC) provides an objective measure of autonomic system regulation through sympathetic-mediated filling of sweat glands. This study aimed to test the utility of SC to detect sympathetic activation in neonatal abstinence syndrome (NAS). Methods 14 term (mean, SE: 38.8 ± 0.35 weeks gestational age) neonates with chronic prenatal opiate exposure were enrolled. SC (peaks/sec and mean of peaks) were measured at baseline, during heel lance/squeeze (HLS) and recovery from HLS at 24-48 (mean 38) hours of life prior to treatment for NAS. Blinded coders with established reliability assessed neonates using the Modified Finnegan Neonatal Scoring System (MFNSS). Non-parametric tests were used to determine group differences, phase differences from baseline to HLS and HLS to recovery, and associations between MFNSS and SC measures. Results Neonates that would later require morphine treatment for NAS (n = 6) had higher baseline SC mean of peaks than those that did not require treatment (n = 8) (P<0.05). Moreover, there were unique phase differences between groups and SC positively correlated with MFNSS (P< 0.05). Conclusion SC provides early identification of NAS severity. However, a larger sample is needed to determine sensitivity and specificity of SC for early identification of NAS and treatment effectiveness.

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Section: Discussionsupporting

confidence: 93%

Skin conductance at baseline and postheel lance reflects sympathetic activation in neonatal opiate withdrawal

et al. 2015

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“…Search one, regarding children, included twelve papers of which five showed the SCR/sec during painful procedures or after observational pain scores were used [8][9][10][11][12]. Only one of these studies examined the SCR/sec during painful/discomfort procedures, and the SCR/sec increased and correlated with the COMFORT sedation score [10].…”

Section: Resultsmentioning

confidence: 99%

“…The remaining three studies showed skin conductance activity during painful procedures, however, the SCR/sec to validate pain was not used [13][14][15]. Search two, regarding infants, included 20 results where four of the papers also were in searh one [8,[10][11][12]. Of the remaining 16, an increase in the SCR/sec during painful procedures was found [6,[16][17][18][19][20][21][22][23][24] (another three which were Russian), or that the SCR/sec was used for developing a pain score by testing variation between and within patients [25,26].…”

Section: Resultsmentioning

confidence: 99%

“…The COMFORT sedation score and the infants' crying time before, during and after painful procedures were also applied while developing the Skin Conductance Algesimeter index. Approximately 400 infants and children participated in these studies [6,8,[10][11][12][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. These studies show that the SCR/sec and observational pain scores increase during defined painful procedures in infants when tested.…”

Section: Emotional Stress Without Arousal No Influence Yesmentioning

confidence: 99%

“…Several studies show that the SCR/sec is not influenced by gestational and postnatal age during painful procedures [6,[20][21][22]26], and also that it is possible to use from 25 weeks of gestational age [6,22] (Figure 2). When a cut off value of 0.571 SCR/sec was used, the sensitivity was 54.5% and the specificity was 79.4 when pain was measured by the Neonatal Facial Coding System (NFCS) [12], the analysing window for the SCR/sec was defined to be only 5 sec. The recommended cut off value is 0.13 SCR/sec to discover moderate and severe pain, and the recommended analysing window is defined to be 15 sec (www.medstorm.com).…”

Section: Emotional Stress Without Arousal No Influence Yesmentioning

confidence: 99%

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The Capability of Skin Conductance to Monitor Pain Compared to Other Physiological Pain Assessment Tools in Children and Neonates

Storm¹

2013

Pediat Therapeut

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Background: In some European countries and the US it is mandatory to assess and treat pain. In Pubmed there are more than 240 papers when searching for "skin conductance" and "pain". Aims: The aim is to review the utility of the skin conductance responses (SCR)/sec to assess pain in infants and children. Study design: Two searches in Pubmed, where one includes the key words "skin conductance", "pain", and "children". Search two included "skin conductance", "pain", and "infants". The finds in these searches are discussed and compared with other physiological pain assessment tools. Outcome measures: Search one; regarding children, included twelve papers, and search two, regarding infants, included 20 papers. Results: All the found papers show that the SCR/sec increases during defined painful procedures. Postoperatively, at intensive care units, and at neonatal units, the SCR/sec shows high sensitivity to monitor pain, but a lower specificity. The the SCR/sec is the most accurate means to assess pain when compared to the HR and peripheral oxygen saturation. HR is influenced from respiratory rhythm, changes in blood volume status, drugs acting on the blood circulation, environmental temperature, and emotional stress, and is therefore less specific to pain than the SCR/sec which only is influenced from emotional stress. For infants and children, variation for SCR/sec is low compared to HR and peripheral oxygen saturation when the patients are at the same pain/discomfort level. Conclusions: The SCR/sec could be adjunctive warning tool for when to validate possible pain.

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The validity of skin conductance for assessing acute pain in mechanically ventilated infants: A cross‐sectional observational study

Harrold

Squires

et al. 2021

European Journal of Pain

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Background: Assessing pain in mechanically ventilated infants is challenging. The assessment of skin conductance (SC) is based on the sympathetic nervous system response to stress. This study purpose was to evaluate the validity of SC for assessing pain in mechanically ventilated infants. Methods: A prospective cross-sectional observational design was used to study SC and its relation to: the category of procedure (i.e., painful or non-painful); the phase of procedure (i.e., before, during and after), and referent pain measurements (i.e., Premature Infant Pain Profile-Revised (PIPP-R) and Neonatal Facial Coding System (NFCS)). Eligible infants were those up to 12 months of age, in intensive care units, who were mechanically ventilated, and required painful and non-painful procedures. Results: From October 2017 to November 2018, 130 eligible infants were identified, and 55 infants were studied. SC (number of waves per second) during painful procedures (median 0.27, interquartile range 0.2-0.4) was statistically significantly higher than those during non-painful procedures (0, 0-0.09). SC during painful procedures was statistically significantly higher than those before (0, 0-0.07) and after painful procedures (0, 0-0.07). SC showed moderate statistically significant positive correlations with PIPP-R (Spearman's rho = 0.4-0.62) and the four-item NFCS (Spearman's rho = 0.31-0.67) before, during and after painful or non-painful procedures respectively. SC had excellent performance (area under the receiver operator curve = 0.979) with excellent sensitivity (92.31%), specificity (95.42%) and negative predictive value (99.21%) but only sufficient positive predictive value (66.67%) when used to discriminate moderate-to-severe pain. Conclusions: SC showed good validity for assessing pain in critically ill infants requiring mechanical ventilation. Significance of the study: Pain assessment in mechanically ventilated infants is challenging. In this study, the validity of skin conductance (SC) for pain assessment is evaluated in the same population of infants during painful and nonpainful procedures. SC showed good validity for assessing acute pain in relation to category of procedure, phase of procedure, and referent pain measurements. SC is a promising method, especially with other pain assessment methods and other determinants of 1995

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Analysis of acute pain scores and skin conductance measurements in infants

Cited by 19 publications

References 33 publications

Skin conductance at baseline and postheel lance reflects sympathetic activation in neonatal opiate withdrawal

Skin conductance at baseline and postheel lance reflects sympathetic activation in neonatal opiate withdrawal

The Capability of Skin Conductance to Monitor Pain Compared to Other Physiological Pain Assessment Tools in Children and Neonates

The validity of skin conductance for assessing acute pain in mechanically ventilated infants: A cross‐sectional observational study

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