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

Abstract

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.

A Preliminary Case Study: Predicting Postoperative Pain Through Electrocardiogram

“…Considering that it is of utmost importance to proper assess pain, there are recent studies showing that common symptoms associated with pain seem to induce a broad heightened sympathetic branch activation of the Autonomic Nervous System (ANS), including increased electrodermal and respiratory activities, cardiac acceleration and heightened muscle contraction [3,6,8,[11][12][13]19,20].…”

“…Pain involves dysregulations in the Autonomic Nervous System (ANS), a primary behavioral regulation system [20]. As the experience of pain induces reactions in the ANS, and, as it functions without conscious control [4], the study of such reactions is a feasible way to assess pain.…”

Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children

“…A skin conductance algesimeter is used to measure the severity of pain in children and adults, unconscious patients, patients under general anesthesia or with verbal communication limitations. This type of pain assessment is therefore considered to be the most objective, [55][56][57] despite the fact that the literature describes technical issues which may cause artifacts, such as electrode dislocation, wire stretching or excessive sweating by the patient. 58 Measuring skin conduction changes is an excellent pain detector, requiring further validation and clinical trials.…”

Comparative evaluation of methods for the detection of electrodermal responses to multilevel intensity thermal noxious stimuli

“…Although some studies have mentioned the low specificity and low predictive values of EDR analysis in assessing pain phenomena or the response to noxious stimulation (Ahmed et al 2015;Ledowski et al 2009;Strehle and Gray 2013;Valkenburg et al 2012), many studies have analyzed EDRs by themselves or in combination with other physiological responses to monitor the pain sensation and try to provide more objective measurements (Ahmed et al 2015;Günther et al 2016;de Jesus et al 2015;Kächele et al, 2015a, b;Loggia et al 2011;Sabourdin et al 2013;Storm 2013;Strehle and Gray 2013;Treister et al 2012;Walter et al 2014;Werner et al 2014).…”