Pupillometry: a non-invasive technique for pain assessment in paediatric patients.

Creator(s)

Mark A. Connelly, Children's Mercy HospitalFollow
Jacob T. Brown
Gregory L. Kearns
Rawni A. Anderson
Shawn D. St Peter, Children's Mercy HospitalFollow
Kathleen A. Neville

Document Type

Article

Publication Date

12-1-2014

Identifier

PMCID: PMC4395877 DOI: 10.1136/archdischild-2014-306286

Abstract

OBJECTIVE: Pupillometry has been used to assess pain intensity and response to analgesic medications in adults. The aim of this observational study was to explore proof of concept for the use of this technique in paediatric patients. Changes in pupil parameters before and after opioid exposure also were evaluated.

DESIGN AND SETTING: This was a single-centre, prospective study conducted at an academic paediatric medical centre.

PATIENTS: Children 9-17 years of age undergoing elective surgical correction of pectus excavatum were enrolled into a protocol approved by the human ethical committee (institutional review board).

INTERVENTIONS: Pupil size and reactivity were measured using a handheld pupillometer. Pain was assessed using age-appropriate, validated pain self-report scales.

RESULTS: Thirty patients were enrolled. Each point change on a 10 cm visual analogue pain intensity scale was associated with a statistically significant mean change of 0.11 mm/s in maximum pupil constriction velocity, and of approximately 0.4% in pupil diameter. As expected, there was an association between total opioid dose (expressed as morphine equivalents) and pupil diameter. Age, sex and baseline anxiety scores did not correlate significantly with pupillary response.

CONCLUSIONS: The association of maximum pupillary constriction velocity and diameter with pain scores illustrates the potential for using pupillometry as a non-invasive method to objectively quantitate pain response/intensity in children. The technique holds promise as a pharmacodynamic 'tool' to assess opioid response in paediatric patients.

Journal Title

Archives of disease in childhood

Volume

99

Issue

12

First Page

1125

Last Page

1131

MeSH Keywords

Adolescent; Analgesics, Opioid; Child; Diagnostic Techniques, Ophthalmological; Female; Humans; Male; Pain; Pain Measurement; Prospective Studies; Pupil; Reflex, Pupillary

Keywords

Analgesia; Pain; Pharmacology; Technology

Comments

Grant support

• UL1 TR000001/TR/NCATS NIH HHS/United States

Recommended Citation

Connelly, M. A., Brown, J. T., Kearns, G. L., Anderson, R. A., St Peter, S. D., Neville, K. A. Pupillometry: a non-invasive technique for pain assessment in paediatric patients. Archives of disease in childhood 99, 1125-1131 (2014).