探索瞳孔動態作爲疼痛客觀測量方法：臨床工具開發

Abstract

準確和客觀的疼痛評估在臨床環境中至關重要，因為依賴主觀患者報告的傳統方法可能會受到個體疼痛閾值和溝通能力的影響。本研究探討了瞳孔動態，特別是綜合瞳孔反應指數（CPRI），作為疼痛客觀測量指標的潛力。作為概念驗證研究，本研究在全身麻醉、區域麻醉和局部麻醉的患者中進行了三次實驗，分析了瞳孔直徑和面積在疼痛刺激下的變化。通過使用先進的瞳孔計和頭戴設備，首先進行了基線測量，然後施加疼痛刺激。數據顯示，瞳孔變化與患者使用數字評定量表（NRS）和鎮痛傷害感受指數（ANImean）報告的疼痛強度之間存在顯著相關性。CPRI作為疼痛的強大指標，表現出與傳統測量方法的高度相關性。

本研究還強調了硬件限制，包括攝像頭距離問題。建議未來與更先進的硬件進行整合，以提高測量精度。目標是開發一種與各種硬件平台兼容的軟件即服務（SaaS）解決方案，提供一個多功能的疼痛管理工具。研究結果表明，這可能在臨床疼痛評估中帶來範式轉變，為醫療提供者提供一個改進患者結果和疼痛管理策略的客觀工具。

Accurate and objective pain assessment is crucial in clinical settings, as traditional methods relying on subjective patient reports can be influenced by individual pain thresholds and communication abilities. This study explores the potential of pupillary dynamics, specifically the Composite Pupillary Response Index (CPRI), as an objective measure of pain. Conducted across three experiments with patients under general, regional, and local anesthesia, we analyzed changes in pupil diameter and area in response to pain stimuli as a proof-of-concept study. Using advanced pupillometry and head-mounted devices, baseline measurements were taken followed by the administration of pain stimuli. The data showed significant correlations between pupillary changes and pain intensity, as reported by patients using the Numeric Rating Scale (NRS) and the Analgesia Nociception Index (ANImean). The CPRI emerged as a robust indicator of pain, with strong correlations to traditional measures.

This study also highlighted hardware limitations, including camera proximity issues. Future integration with more advanced hardware is recommended to enhance measurement accuracy. The goal is to develop a software-as-a-service (SaaS) solution compatible with various hardware platforms, providing a versatile tool for pain management. The findings suggest a potential paradigm shift in clinical pain assessment, offering healthcare providers an objective tool to improve patient outcomes and pain management strategies.