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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Werner, Mads

CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

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Volume 16, Issue 1


Cerebral oxygenation for pain monitoring in adults is ineffective: A sequence-randomized, sham controlled study in volunteers

Christine H. Meyer-Frießem
  • Corresponding author
  • Department of Anaesthesiology, Intensive Care Medicine, Palliative Care and Pain Management, BG-Universitätsklinikum Bergmannsheil GmbH Bochum, Medical Faculty of Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Gunnar Jess
  • Department of Anaesthesiology, Intensive Care Medicine, Palliative Care and Pain Management, BG-Universitätsklinikum Bergmannsheil GmbH Bochum, Medical Faculty of Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Esther M. Pogatzki-Zahn
  • Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer-Campus 1 (Building A1), 48149 Münster, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Peter K. Zahn
  • Department of Anaesthesiology, Intensive Care Medicine, Palliative Care and Pain Management, BG-Universitätsklinikum Bergmannsheil GmbH Bochum, Medical Faculty of Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-07-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.05.001



Pain assessment by Numeric Rating Scale (NRS) is considered to be good clinical practice, but objective pain assessment is still a challenge. Near infrared spectroscopy (NIRS) measures cerebral tissue oxygen saturation (SctO2) that increases with cortical-neuronal activity and may provide point-of-care bedside pain monitoring. Analogous to promising studies in newborns, we hypothesize that different levels of SctO2 can probably quantify pain intensity. SctO2 may increase following painful in contrast to non-painful or sham stimuli and may correlate with pain intensity as assessed by NRS in volunteers.


Twenty healthy male students (24.2±1.9 years), recruited via local advertising, were consecutively included in a sequence-randomized, sham-controlled, single-blinded study. SctO2 was recorded continuously with two NIRS sensors on the forehead. After resting, four stimuli were applied in a random order on the right forearm (unexpected and expected electrical pain, expected non-painful and sham stimuli). Blinded subjects were asked to rate each stimulus on NRS. Statistics: RM-ANOVA; Wilcoxon or paired Student t-test; Spearman’s rank correlation; P < .05.


Resting volunteers showed SctO2 of 72.65%±3.39. SctO2 significantly increased for about 60 to 70s until a maximum after unexpected painful (74.62%±3.9; P = .022) and sham stimuli (74.07%±3.23; P =.014). Expected painful (P =.139) and non-painful stimuli (P =.455) resulted in no changes in SctO2. NRS scores (median, IQR) were rated significantly higher after expected (5.25, 3.5 to 6.75) than after unexpected (4.5, 3 to 5; P = .008) pain. No strong correlation was found between NRS and SctO2.

Conclusions and Implications

Contrary to our expectations, measuring SctO2 via a two-channel NIRS is not able to remediate the lack of objective bedside pain assessment under standardized experimental conditions in alert adults.

Keywords: Pain monitoring; Cerebral oxygen saturation; NIRS; Near infrared spectroscopy; SctO2


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About the article

Received: 2017-03-22

Revised: 2017-05-01

Accepted: 2017-05-02

Published Online: 2017-07-01

Published in Print: 2017-07-01

Ethical issues: Procedures were proposed to each participant and written informed consent in accordance to the Declaration of Helsinki was obtained. Institutional Review Board: Ethics Committee of the Faculty of Medicine of the Ruhr University Bochum, Germany Chairman: Prof. Dr. M. Zenz; Gesundheitscampus 33, 44801 Bochum, Germany; No. 4501-12; approval: 23 Oct 2012.

Conflict of interest: CMF: received a sponsorship award for young pain scientists 2012 from Janssen-Cilag GmbH. Further, she received payments for clinical lectures from OrionPharma and Grünenthal Group 2013, all unrelated to the current study and relationships in the past. GJ: none known. EPZ: received consultancy fees from Mundipharma, MSD, Janssen-Cilag and Grünenthal. EPZ has a grant pending from Mundipharma. She has received payment for lectures from Mundipharma, Lilly, MSD, Pfizer and Grünenthal, and travel/accommodation/meetings expenses unrelated to other activities from Mundipharma. Funding was not related to the present research. PZ: none known.

Funding: Costs of this study (e.g. expendable materials, proband fees) were obtained from institutional sources.

Authors’ contributions: CMF: drafted ethical proposal and manuscript, performed statistics; GJ: collected data, did statistical analyses; EMPZ: responsible for concept, gave advice and made critical revisions; PKZ: responsible for concept, participated in drafting the manuscript.

Citation Information: Scandinavian Journal of Pain, Volume 16, Issue 1, Pages 129–135, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.05.001.

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