Objective Pain Measures in Awake Sedated, Anesthetized Individuals with NIRS

描述(由申请人提供)：在美国，每年进行的手术超过2300万例。目前还没有针对手术中疼痛的客观措施。在过去的几年里，我们开发了近红外光谱(NIRS)的使用，以提供疼痛感觉的客观测量。近红外光谱(NIRS)系统简单、便携，很容易在手术室中使用，使医生能够测量与疼痛感觉(初级体感皮质，SI)或运动规划/逃避(辅助运动皮质，SMA)有关的特定大脑区域的活动。我们已经从辅助运动和前额叶皮质识别出特定的疼痛信号。我们现在建议推进NIRS技术，使这种疼痛生物标志物的测量在临床环境中更加可靠，在受控的临床相关条件下验证该测量，然后展示在手术室环境中监测疼痛感觉的临床实用价值。我们的假设是，在麻醉过程中，NIRS客观测量初级躯体感觉和前额叶皮质对间歇性疼痛刺激的神经活动，将反映麻醉下止痛阻滞的有效性。为了验证这一假设，已经产生了三个具体目标：(1)通过改进信号处理来过滤系统干扰并动态估计疼痛生物标记物，促进近红外光谱技术在手术室环境中的应用；(2)通过评估阿片类药物(吗啡)对健康男性和女性的止痛效果来验证客观的疼痛测量；并在接受结肠镜检查的其他健康男性和女性身上测试镇静下的疼痛措施；以及(3)将这些措施转化为接受吸入麻醉或全静脉麻醉的患者。这些目标的成功完成将为麻醉师提供一种新的工具来优化对患者的管理，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.