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A new pupillary measure to assess pain: a prospective study.

A new pupillary measure to assess pain: a prospective study.
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Charier DJ, Zantour D, Pichot V, Chouchou F, Barthelemy JM, Roche F, Molliex SB,


Charier DJ, Zantour D, Pichot V, Chouchou F, Barthelemy JM, Roche F, Molliex SB, (click to view)

Charier DJ, Zantour D, Pichot V, Chouchou F, Barthelemy JM, Roche F, Molliex SB,

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The journal of pain : official journal of the American Pain Society 2017 07 12() pii S1526-5900(17)30629-6
Abstract

Pupillary diameter (PD) varies under the influence of both the sympathetic and parasympathetic systems, increasing proportionally to pain intensity. Such variations however should not be confused with pupillary fluctuations, which refer to the fast and permanent PD fluctuations induced by the ongoing interplay between the sympathetic and parasympathetic systems, which we propose to measure using the Variation Coefficient of Pupillary Diameter (VCPD). This study aimed first at correlating both PD, PD increase during a contraction, and VCPD, with pain as rated with the Numerical Rating Scale (NRS) during obstetrical labor, and then at comparing such correlations with one another. Forty patients were included in the study, and 160 simultaneous ratings (NRS, PD and VCPD) were taken: 40 in the presence of uterine contractions and 40 in the absence of such contractions, both before and 20 minutes after epidural analgesia. VCPD correlates more strongly (r = 0.77) than PD increase (r = 0.42) with pain as rated with NRS. The ability of VCPD to predict the occurrence of NRS ≥ 4 during obstetrical labor is 0.97 (Confidence Interval: 0.93-1.0). When measured over 10 seconds during contraction, VCPD correlates more strongly than PD increase with pain as rated with the NRS. Such stronger correlation allows for an easy assessment of antinociception-nociception balance.

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