Objective Pain Measures in Awake Sedated, Anesthetized Individuals with NIRS

描述（由申请人提供）：美国每年进行超过2300万例手术。目前还没有客观的测量手术疼痛的方法。在过去的几年里，我们已经开发了使用近红外光谱（NIRS）来提供疼痛感觉的客观测量。近红外光谱（NIRS）系统简单便携，易于在手术室中应用，使医生能够测量涉及疼痛感觉（初级体感皮层，SI）或运动计划/逃避（辅助运动皮层，SMA）的特定大脑区域的活动。我们已经确定了一个特定的疼痛信号从辅助运动和前额皮质。我们现在建议推进近红外光谱技术，使这种疼痛生物标志物的测量在临床环境中更加稳健，在临床相关的受控条件下验证该测量，然后展示在手术室环境中监测疼痛感觉的临床效用。我们的假设是，在麻醉过程中，通过近红外光谱客观测量初级体感皮层和前额叶皮层对间歇性疼痛刺激的神经活动，可以反映麻醉时镇痛阻断的有效性。为了验证这一假设，研究人员提出了三个具体目标：(1)通过推进信号处理来过滤系统干扰并动态估计疼痛生物标志物，从而推进手术室环境中的近红外光谱技术；(2)通过评价阿片类药物（吗啡）在健康男性和女性中的镇痛作用来验证疼痛的客观测量；并在接受结肠镜检查的健康男性和女性中测试镇静下的疼痛测量；(3)将这些措施应用于吸入麻醉或全静脉麻醉患者。成功完成这些目标将为麻醉师提供一个新的工具来优化患者的管理，以减少围手术期疼痛相关后遗症的发生率。我们已经组建了一个跨学科的团队（NIRS专家、疼痛专家和医生）来承担和完成拟议的研究。

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.