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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

4 Issues per year

CiteScore 2017: 0.84

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Source Normalized Impact per Paper (SNIP) 2017: 0.452

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Volume 18, Issue 4

Measurement of skin conductance responses to evaluate procedural pain in the perioperative setting

Morten Svalebjørg
  • Corresponding author
  • Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Hanne Storm
  • The Simulation Centre, Division of Emergencies and Critical Care, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Roy Bjørkholt Olsen / Jan Frederik Bugge
  • Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-07-26 | DOI: https://doi.org/10.1515/sjpain-2018-0088


Background and aims

The subjective nature of pain makes objective, quantitative measurements challenging. The current gold standard for evaluating pain is patient self-reporting using the numeric rating scale (NRS) or Visual Analog Scale. Skin conductance responses per second (SCR) measured in the palmar region reflect the emotional part of the autonomous nervous system. SCR ≥0.20 have been shown to indicate moderate or severe pain in the postoperative setting. We examined whether SCR can detect procedure-related pain before major surgery.


In 20 patients being prepared for major surgery SCR was recorded before and during arterial cannulation, after induction of anaesthesia, and on the first postoperative day. Self-reported pain was evaluated using NRS. NRS >3 was considered to represent moderate or severe pain.


NRS was 0 [0–0] before arterial cannulation, increasing to 5 [3–6] during arterial cannulation (p<0.05). Before arterial cannulation SCR was 0.27 [0.20–0.27], increasing to 0.33 [0.30–0.37] during arterial cannulation (p<0.01). On the first postoperative day both SCR and reported pain indicated no more than mild pain, SCR 0.13 [0.00–0.20] and NRS 2.0 [0.5–2.0]. The sensitivity of SCR to indicate moderate or severe pain (NRS >3) was 0.93 (0.68–1.0) and specificity was 0.33 (0.25–0.35) when the cut-off established in the postoperative setting (SCR ≥0.20) was used on all data.


SCR increased during arterial cannulation. Before major surgery the SCR was above the threshold demonstrated to indicate pain in the postoperative setting, even without painful stimuli and no reported pain. Using the threshold established for postoperative pain, SCR cannot reliably discriminate between pain and other stressors before major surgery.


Before major surgery, the diagnosis of moderate or severe pain should not be made based on SCR ≥0.20.

Keywords: pain; anxiety; skin conductance responses; numeric rating scale; NRS


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About the article

Corresponding author: Morten Svalebjørg, MD, Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway, Phone: +47 23073700, Fax: +47 23073690

Received: 2018-05-16

Revised: 2018-06-29

Accepted: 2018-07-01

Published Online: 2018-07-26

Published in Print: 2018-10-25

Authors’ statements

Research funding: Vingmed, Fjordveien 1, 1363 Høvik, Norway, supplied the skin conductance algesimeter and electrodes used in this study free of charge.

Conflict of interest: M. Svalebjørg, R.B. Olsen and J.F. Bugge have no conflicts of interest related to this work. Hanne Storm is founder and co-owner of Med-Storm Innovation AS that owns the patents for the skin conductance technology used to assess pain in this study.

Informed consent: Informed consent was obtained from all individual participants included in the study.

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Citation Information: Scandinavian Journal of Pain, Volume 18, Issue 4, Pages 639–644, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2018-0088.

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©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved..Get Permission

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