Quantitative Assessment of Dental Pain using a smartphone-attachable electrodermal activity sensor

项目摘要/摘要 我们的长期目标是为牙痛开发一种个性化的疼痛控制策略，这是主要的 患者寻求牙科治疗的原因。对牙痛进行客观和定量的评估对于 开发有效的疼痛控制治疗方法。准确诊断牙痛的根源至关重要，因为有些人 这种情况不仅会导致极度的疼痛，甚至会危及生命。当前牙科疼痛的诊断 完全依赖于患者的主观反应，当患者无法 沟通，如幼儿和有认知障碍或语言问题的个人。 减少牙科治疗期间和之后的疼痛是患者和牙医关注的另一个重要问题。 嘴唇和舌头麻木通常被用作下颌牙齿局部麻醉成功的标志。 这种方法相当无效，因为30%-40%的患者在治疗过程中仍会感到疼痛。此外， 止痛药的选择在一定程度上是由患者驱动的，这可能导致阿片类药物的滥用。这个探索性项目 目的测试皮肤电活动(EDA)能否客观、可靠地评估牙痛。 当我们经历疼痛时，我们的交感神经系统(SNS)的活动会增加。尽管 SNS在牙痛中的作用尚不完全清楚，交感神经纤维数量增加 据报道，在受感染牙齿的牙髓中。EDA设备测量手指上的皮肤电导，这一点非常强烈 与汗液分泌相关，并唯一反映了社交网络的活跃程度。当健康的牙齿受到寒冷的时候 和电刺激，患者感觉到一种很快恢复的感觉。在我们的初步研究中，这种感觉 与使用时变索引(TVSymp)算法的EDA记录高度相关，我们 发展起来的。因此，我们假设EDA的时变指数(TVSymp)可以反映牙髓的状态，并且是 一种针对牙齿疼痛的敏感而具体的测量方法。在这项拟议的研究中，我们将开发一种基于智能手机的 用于TVSymp数据收集和分析的小型EDA系统(目标1)。这款基于智能手机的低成本产品 EDA设备可以轻松地在临床环境中使用，并用于无线报告患者的疼痛程度 回家，例如手术后，更好地调整止痛药。它还可以提高合规性 未来临床疼痛研究的参与者。我们将确定TVSymp是否可以可靠地用于诊断 牙髓状态和评估牙痛程度使用现有的大型EDA设备以及 基于智能手机的设备一旦准备好即可使用(目标2)。如果成功，TVSymp录制将改善 牙髓诊断的准确性，并成为牙痛的一种新的生物标志物，取代主观的疼痛报告。 这个项目在概念上和技术上都是新颖的，因为：1)SNS的活性从未用于纸浆 诊断和评估牙痛；2)TVSymp指数比 在以前的疼痛评估研究中使用的其他EDA指数。这项研究的发现有很大的潜力 显著影响牙科护理和牙科疼痛研究。

Project Summary/Abstract Our long-term goal is to develop a personalized pain-control strategy for toothache, which is the primary reason patients seek dental treatment. An objective and quantitative assessment of dental pain is essential to develop efficient treatment for pain control. Diagnosing the source for toothache accurately is crucial as some conditions not only can cause excruciating pain but even be life-threatening. Current dental pain diagnosis relies fully on subjective responses from patients, which is problematic when patients are unable to communicate such as young children and individuals with cognitive disorders or langauge problems. Minimizing pain during and after dental treatment is another important concern for patients and dentists. Numbness of lip and tongue is typically used as a sign of successful local anesthesia for teeth of the lower jaw. This method is rather ineffective, as 30-40% of patients still experience pain during treatment. Furthermore, the selection of painkillers is partially patient-driven, which can lead to the abuse of opiods. This exploratory project aims to test whether electrodermal activity (EDA) can be used to assess dental pain objectively and reliably. When we experience pain, our activity of the sympathetic nervous system (SNS) is increased. Although the role of the SNS in dental pain is not fully understood, increased numbers of sympathetic nerve fibers have been reported in the pulp of infected teeth. EDA devices measure skin conductance on fingers, which strongly correlates to sweat production and exclusively mirrors acitivity of the SNS. When healthy teeth receive cold and electrical stimulation, patients feel a sensation that recovers quickly. In our pilot study, such sensations were highly correlated with EDA recordings using a time-varying index (TVSymp) algorithm, which we developed. We thus hypothesize that the time-varying index (TVSymp) of EDA can reflect pulpal status and is a sensitive and specific measure for dental pain. In this proposed study, we will develop a smartphone-based miniaturized EDA system for data collection and analysis of TVSymp (Aim 1). This low-cost smartphone-based EDA device could easily be used in clinical settings and for wireless reporting of pain levels from a patient’s home, for example after surgery, to better adjust pain medication. It may also enhance compliance of participants in future clinical pain studies. We will determine whether TVSymp can reliably be used to diagnose pulpal status and assess levels of dental pain using the existing large-sized EDA device as well as the smartphone-based device once ready to use (Aim 2). If successful, TVSymp recordings would improve the accuracy of pulpal diagnosis and be a novel biomarker for dental pain to replace subjective pain reporting. This project is conceptually and technically novel because: 1) the activity of SNS has never been used for pulp diagnosis and assessing dental pain; 2) the TVSymp index is more sensitive and more consistent compared to other EDA indices used in previous pain assessment studies. Findings from this study have a great potential to significantly impact dental care and dental pain research.