title: Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy.
abstract: Colonoscopy is an invaluable tool for the screening and diagnosis of many colonic diseases. For most colonoscopies, moderate sedation is used during the procedure. However, insufflation of the colon produces a nociceptive stimulus that is usually accompanied by facial grimacing/groaning while under sedation. The objective of this study was to evaluate whether a nociceptive signal elicited by colonic insufflation could be measured from the brain. Seventeen otherwise healthy patients (age 54.8 ± 9.1; 6 female) undergoing routine colonoscopy (ie, no history of significant medical conditions) were monitored using near-infrared spectroscopy (NIRS). Moderate sedation was produced using standard clinical protocols for midazolam and meperidine, titrated to effect. Near-infrared spectroscopy data captured during the procedure was analyzed offline to evaluate the brains' responses to nociceptive stimuli evoked by the insufflation events (defined by physician or observing patients' facial responses). Analysis of NIRS data revealed a specific, reproducible prefrontal cortex activity corresponding to times when patients grimaced. The pattern of the activation is similar to that previously observed during nociceptive stimuli in awake healthy individuals, suggesting that this approach may be used to evaluate brain activity evoked by nociceptive stimuli under sedation, when there is incomplete analgesia. Although some patients report recollection of procedural pain after the procedure, the effects of repeated nociceptive stimuli in surgical patients may contribute to postoperative changes including chronic pain. The results from this study indicate that NIRS may be a suitable technology for continuous nociceptive afferent monitoring in patients undergoing sedation and could have applications under sedation or anesthesia.
authors.affiliation: P.A.I.N. Group, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA Center for Pain and the Brain, Harvard Medical School, Boston, MA, USA Departments of Radiology Anesthesia and Critical Care, and Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Lino
authors.initials: L
authors.lastname: Becerra
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Aasted
authors.forename: David A
authors.initials: DA
authors.lastname: Boas
authors.forename: Edward
authors.initials: E
authors.lastname: George
authors.forename: Meryem A
authors.initials: MA
authors.lastname: Yücel
authors.forename: Barry D
authors.initials: BD
authors.lastname: Kussman
authors.forename: Peter
authors.initials: P
authors.lastname: Kelsey
authors.forename: David
authors.initials: D
authors.lastname: Borsook
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D003113:Colonoscopy / Q000379:methods; D016292:Procedural Sedation / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D059225:Nociception / Q000502:physiology*; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D059408:Pain Management / Q000379:methods; D019265:Spectroscopy, Near-Infrared
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam