FR2624373A1 - Device for measuring pain - Google Patents

Device for measuring pain Download PDF

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Publication number
FR2624373A1
FR2624373A1 FR8717609A FR8717609A FR2624373A1 FR 2624373 A1 FR2624373 A1 FR 2624373A1 FR 8717609 A FR8717609 A FR 8717609A FR 8717609 A FR8717609 A FR 8717609A FR 2624373 A1 FR2624373 A1 FR 2624373A1
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France
Prior art keywords
pain
reflexes
measurement
nociceptive
objective
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FR8717609A
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French (fr)
Inventor
Jean Vincent Willer
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RACIA SA
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RACIA SA
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Priority to FR8717609A priority Critical patent/FR2624373A1/en
Publication of FR2624373A1 publication Critical patent/FR2624373A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4824—Touch or pain perception evaluation

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Physics & Mathematics (AREA)
  • Pain & Pain Management (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Hospice & Palliative Care (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Psychiatry (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Electrotherapy Devices (AREA)

Abstract

The present invention relates to the objective measurement of pain caused by a reproducible and quantifiable stimulation, as well as to an apparatus for, on the one hand, carrying out these objective measurements as a function of the stimulations made, and, on the other hand, for allowing medical applications permitted by these objective measurements to be carried out. Numerous methods have been explored for allowing the measurement of different types of pain caused. Most of them require the participation of the patient for quantifying the pain felt: they do not under these conditions allow objective measurement. The others rely on measurable phenomena linked with the pain, but whose relationship with the pain is imprecise or unstable. A first object of the present invention is to provide a method and means for objective, reliable and precise measurement of certain types of pain caused.

Description

La présente invention concerne la mesure objective de la douleur provoquée par une stimulation reproductible et quantifiable ainsi qu'un appareil pour effectuer d'une part ces mesures objectives en fonction des stimulations effectuées et pour permettre d'autre part de réaliser les applications médicales permises par ces mesures objectives. The present invention relates to the objective measurement of the pain caused by a reproducible and quantifiable stimulation as well as an apparatus for carrying out on the one hand these objective measurements as a function of the stimulations carried out and for allowing on the other hand to carry out the medical applications permitted by these objective measures.

De nombreuses méthodes ont eété explore as pour permettTe la mesure de différentes douleurs provoquées. La plupart d'entre elles demandent la participation du patient pour quantifier la douleur ressentie : elles ne permettent pas dans ces conditions une mesure objective. Les autres s'appuient sur des phénomènes mesurables liés à la douleur, mais dont la relation avec la douleur est imprécise ou instable. Un premier objet de la présente invention est de proposer une méthode et des moyens de mesure objective, fiable et précise de certaines douleurs provoquées.Un second objet de la présente invention est de proposer une méthode et des moyens de mesure de l'évolution d'une douleur naturelle d'origine quelconque (post-opératoire, chronique, post-traumatique ou autre), de mesure de lteffizacité d'un traitement analgésique (chirurgical, médicamenteux ou autre), mesure de l'efficacité d'une anesthésie, dosage d'un analgésique ou d'un anesthésique, évolution des convias et tout autre application médicale de même type. Numerous methods have been explored to allow the measurement of different pains caused. Most of them require the patient's participation to quantify the pain felt: they do not allow an objective measurement under these conditions. The rest are based on measurable phenomena related to pain, but whose relationship to pain is imprecise or unstable. A first object of the present invention is to propose a method and means for objective, reliable and precise measurement of certain pains caused. A second object of the present invention is to propose a method and means to measure the evolution of natural pain of any origin (post-operative, chronic, post-traumatic or other), measuring the effectiveness of an analgesic treatment (surgical, drug or other), measuring the effectiveness of anesthesia, dosage of '' an analgesic or anesthetic, evolution of convias and any other medical application of the same type.

L'invention procede de la découverte que certains reflexes nociceptifs de flexion (réflexes de retrait devant la douleur)-chez l'homme, provoquée par une stimulation appropriée, ont une grandeur qui est une fonction de la douleur ressentie pendant cette stimulation. The invention proceeds from the discovery that certain nociceptive flexion reflexes (withdrawal reflexes in pain) in humans, caused by appropriate stimulation, have a magnitude which is a function of the pain experienced during this stimulation.

Cette fonction est croissante et biunivoque jusqu'à un certain seuil, associable à une douleur intolérable, au-delà duquel la grandeur des réflexes n'augmente plus Et la croissance commence dès le seuil de sensation de douleur. This function is increasing and one-to-one up to a certain threshold, associated with intolerable pain, beyond which the size of the reflexes no longer increases And growth begins as soon as the pain sensation threshold.

L'existence de cette fonction biunivoque permet tout d'abord de proposer une mesure de la douleur à partir de celle des réflexes nociceptifs de flexion. S'appuyant sur un réflexe, cette mesure est objective pour un même patient.  The existence of this one-to-one function makes it possible first of all to propose a measurement of pain starting from that of the nociceptive flexion reflexes. Based on a reflex, this measurement is objective for the same patient.

Enfin, si l'on utilise une stimulation parfaitement maitrisée, la mesure de la douleur provoquée permettra une mesure d'une douleur se superposant à la douleur provoquée. Finally, if a perfectly controlled stimulation is used, the measurement of the pain caused will allow a measurement of pain superimposed on the pain caused.

La présente invention propose un appareil pour déterminer objectivement tout ou partie de cette fonction biunivoque, et d'en suivre dans le temps l'évolution soit spontanée, soit consécutive à des actions médicales ou chirurgicales. L'appareil comprend un stimulateur aux stimuli modulables et mesurables (intensité, forme, répétition),un système de mesure précis et fiable de la grandeur des réflexes nociceptifs de flexion provoqués, et un moyen de conserver les valeurs des grandeurs des réflexes nociceptifs avec les intensités de stimulations et la chronologie de ces stimulations. The present invention provides an apparatus for objectively determining all or part of this one-to-one function, and for monitoring its evolution over time either spontaneously or following medical or surgical actions. The apparatus comprises a stimulator with modular and measurable stimuli (intensity, shape, repetition), a system for precise and reliable measurement of the magnitude of the noxious reflexes of flexion caused, and a means of preserving the values of the magnitudes of the noxious reflexes with the stimulation intensities and the chronology of these stimulations.

Pour permettre de mieux comprendre l'invention, celle-ci sera maintenant décrite à titre d'exemple, en se référant à la figure annexée, sous la forme selon laquelle elle a été développée jusqu'à présent. To allow a better understanding of the invention, it will now be described by way of example, with reference to the appended figure, in the form in which it has been developed up to now.

La première réalisation de l'invention comprend - un stimulateur électrique (1), dont les paramètres sont sélectionnables à tout instant, notamment l'intensité du courant délivré et la forme des stimuli,et dont le déclenchement peut être commandé soit manuellement au coup par coup, soit d'une manière automatique à intervalles de temps sélectionnables.Il comporte un système assurant que l'intensité électrique délivrée au patient au travers d'électrodes cutanées est celle demandée - un système de recueil du signal électrique physiologique associé au réflexe nociceptif et recueilli sur les muscles fléchisseurs (2) comprenant des électrodes de réception et une chaine d'amplification
Il peut travailler sur deux réflexes nociceptifs simultanément;; - un système (3) de numérisation des signaux physiologiques recueillis sur une durée préseléctionnable puis de traitement numérique pour
calculer la surface délimitée d'une part par la courbe représenta
tive de l'amplitude des signaux électrophysiologiques précités en fonction du temps et par la ligne de référence électrique d autre part La correction de bruit de fond est effectuée en limitant la surface calculée entre deux valeurs du temps encadrant stictement
la réponse électrophysiologique réflexe. The first embodiment of the invention comprises - an electric stimulator (1), the parameters of which can be selected at any time, in particular the intensity of the current delivered and the shape of the stimuli, and the triggering of which can be controlled either manually by hand by suddenly, either automatically at selectable time intervals. It includes a system ensuring that the electrical intensity delivered to the patient through skin electrodes is that required - a system for collecting the physiological electrical signal associated with the nociceptive reflex and collected on the flexor muscles (2) comprising receiving electrodes and an amplification chain
It can work on two nociceptive reflexes simultaneously; - a system (3) for digitizing the physiological signals collected over a preselectable period then digital processing for
calculate the area delimited on the one hand by the curve represented
tive of the amplitude of the aforementioned electrophysiological signals as a function of time and by the electrical reference line on the other hand The correction of background noise is carried out by limiting the area calculated between two values of time stictly framing
the reflex electrophysiological response.

- un système de présentation sur le tube cathodique des valeurs des surfaces calculées comme précédemment en fonction de l'intensité de stimulation utilisée, permettant la détermination visuelle de la fonction linéaire de corrélation intensité-douleur; - un système de présentation sur le tube cathodique des valeurs des surfaces calculées comme précédemment en fonction du temps; - une imprimante (5) permettant de recopier les écrans; - un système d'archivage sur disquette (6) des données acquises; - un pupitre de commande (7) pour gérer l'ensemble.  - a system of presentation on the cathode ray tube of the values of the surfaces calculated as above as a function of the intensity of stimulation used, allowing the visual determination of the linear function of intensity-pain correlation; - a system for presenting on the cathode ray tube the values of the surfaces calculated as above as a function of time; - a printer (5) making it possible to copy the screens; - an archive system on diskette (6) of the acquired data; - a control console (7) to manage the assembly.

Claims (10)

REVENDICATIONS 1) Dispositif pour mesurer la douleur caractérisé en ce qu'il est constitué d'un système délivrant une stimulation douloureuse d'intensité variable et mesurable, associé à un système mesurant la grandeur des réflexes nociceptifs de flexion associés. 1) Device for measuring pain characterized in that it consists of a system delivering painful stimulation of variable and measurable intensity, associated with a system measuring the size of the associated nociceptive flexion reflexes. 2) Dispositif selon la revendication (1), caractérisé en ce qu'il mémorise, avec la grandeur des réflexes nociceptifs de flexion provoqués, leur ordre et leur chronologie. 2) Device according to claim (1), characterized in that it stores, with the magnitude of the nociceptive flexion reflexes caused, their order and their chronology. 3) Dispositif selon la revendication (2), caractérisé en ce qu'il effectue la mémorisation sur une mémoire informatique. 3) Device according to claim (2), characterized in that it performs the storage on a computer memory. 4) Dispositif selon la revendication (1), (2) ou (3) caracterisé en ce qu'il mesure la grandeur des réflexes nociceptifs de flexion par la surface délimitée d'une part par la courbe représentative du signal électrophysiologique recueilli par deux électrodes sur les muscles fléchisseurs et d'autre part par la ligne de référence électrique. 4) Device according to claim (1), (2) or (3) characterized in that it measures the magnitude of the nociceptive bending reflexes by the surface delimited on the one hand by the curve representative of the electrophysiological signal collected by two electrodes on the flexor muscles and on the other hand by the electrical reference line. 5) Dispositif selon la revendication (4), caractérisé en ce qu'il mémorise la forme des surfaces avec l'ordre et la chronologie de leur obtention. 5) Device according to claim (4), characterized in that it memorizes the shape of the surfaces with the order and the chronology of their obtaining. 6) Dispositif selon la revendication (5), caractérisé en ce qu'il effectue la mémorisation sur mémoire informatique. 6) Device according to claim (5), characterized in that it performs storage on computer memory. 7) Dispositif selon l'une quelconque des revendications précédentes qui présente d'une manière synthétique l'évolution dans le temps de la grandeur des réflexes nociceptifs de flexion obtenus avec une même stimulation. 7) Device according to any one of the preceding claims which presents in a synthetic manner the evolution over time of the magnitude of the nociceptive flexion reflexes obtained with the same stimulation. 8) Dispositif selon la revendication (7) qui présente d'une manière synthétique la grandeur des réflexes nociceptifs en fonction de l'heure douleur obtention. 8) Device according to claim (7) which presents in a synthetic manner the size of the nociceptive reflexes as a function of the time of pain obtaining. 9) Dispositif selon l'une quelconque des revendications (4), (5), (6), (7), (8), caractérisé en ce que la mesure de la surface définie dans la revendication (4) est diminuée de la surface due au seul bruit de fond. 9) Device according to any one of claims (4), (5), (6), (7), (8), characterized in that the measurement of the surface defined in claim (4) is reduced by the surface due to the only background noise. 10) Dispositif selon la revendication (9) caractérisé en ce. 10) Device according to claim (9) characterized in that. que la correction de mesure pour le bruit de fond est effectuée en limitant la surface calculée entre deux valeurs du temps encadrant strictement la réponse physiologique réflexe. that the measurement correction for background noise is carried out by limiting the area calculated between two values of time strictly framing the physiological reflex response.
FR8717609A 1987-12-14 1987-12-14 Device for measuring pain Withdrawn FR2624373A1 (en)

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FR8717609A FR2624373A1 (en) 1987-12-14 1987-12-14 Device for measuring pain

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FR8717609A FR2624373A1 (en) 1987-12-14 1987-12-14 Device for measuring pain

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Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999029367A1 (en) * 1997-12-12 1999-06-17 Empi Corp. Externally worn medical device
US6044303A (en) * 1995-09-13 2000-03-28 Empi Corp. TENS device with electronic pain intensity scale
AU727486B2 (en) * 1996-01-02 2000-12-14 Cefar Matcher Ab Measuring of pain
EP2417901A1 (en) * 2010-08-12 2012-02-15 Idmed Method and device for monitoring stimuli
US11026627B2 (en) 2013-03-15 2021-06-08 Cadwell Laboratories, Inc. Surgical instruments for determining a location of a nerve during a procedure
US11177610B2 (en) 2017-01-23 2021-11-16 Cadwell Laboratories, ino. Neuromonitoring connection system
US11253182B2 (en) 2018-05-04 2022-02-22 Cadwell Laboratories, Inc. Apparatus and method for polyphasic multi-output constant-current and constant-voltage neurophysiological stimulation
US11443649B2 (en) 2018-06-29 2022-09-13 Cadwell Laboratories, Inc. Neurophysiological monitoring training simulator
US11992339B2 (en) 2018-05-04 2024-05-28 Cadwell Laboratories, Inc. Systems and methods for dynamic neurophysiological stimulation

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR1519720A (en) * 1967-02-20 1968-04-05 Automatic behavior analyzer
GB1557349A (en) * 1977-02-17 1979-12-05 Medicor Muevek Process and apparatus for measuring electrical parameters of nerve and muscle tissue
EP0025222A2 (en) * 1979-09-10 1981-03-18 The Regents Of The University Of California Apparatus for monitoring neuromuscular transmission
DE3601930A1 (en) * 1986-01-23 1987-07-30 Physiomed Medizintechnik Gmbh Stimulating current diagnostic apparatus

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR1519720A (en) * 1967-02-20 1968-04-05 Automatic behavior analyzer
GB1557349A (en) * 1977-02-17 1979-12-05 Medicor Muevek Process and apparatus for measuring electrical parameters of nerve and muscle tissue
EP0025222A2 (en) * 1979-09-10 1981-03-18 The Regents Of The University Of California Apparatus for monitoring neuromuscular transmission
DE3601930A1 (en) * 1986-01-23 1987-07-30 Physiomed Medizintechnik Gmbh Stimulating current diagnostic apparatus

Cited By (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6044303A (en) * 1995-09-13 2000-03-28 Empi Corp. TENS device with electronic pain intensity scale
AU727486B2 (en) * 1996-01-02 2000-12-14 Cefar Matcher Ab Measuring of pain
WO1999029367A1 (en) * 1997-12-12 1999-06-17 Empi Corp. Externally worn medical device
EP2417901A1 (en) * 2010-08-12 2012-02-15 Idmed Method and device for monitoring stimuli
FR2963732A1 (en) * 2010-08-12 2012-02-17 Idmed METHOD FOR CONTROLLING STIMULI APPLIED TO AN ANIMAL OR HUMAN SUBJECT
US11026627B2 (en) 2013-03-15 2021-06-08 Cadwell Laboratories, Inc. Surgical instruments for determining a location of a nerve during a procedure
US11177610B2 (en) 2017-01-23 2021-11-16 Cadwell Laboratories, ino. Neuromonitoring connection system
US11949188B2 (en) 2017-01-23 2024-04-02 Cadwell Laboratories, Inc. Methods for concurrently forming multiple electrical connections in a neuro-monitoring system
US11253182B2 (en) 2018-05-04 2022-02-22 Cadwell Laboratories, Inc. Apparatus and method for polyphasic multi-output constant-current and constant-voltage neurophysiological stimulation
US11992339B2 (en) 2018-05-04 2024-05-28 Cadwell Laboratories, Inc. Systems and methods for dynamic neurophysiological stimulation
US11998338B2 (en) 2018-05-04 2024-06-04 Cadwell Laboratories, Inc. Systems and methods for dynamically switching output port cathode and anode designations
US11443649B2 (en) 2018-06-29 2022-09-13 Cadwell Laboratories, Inc. Neurophysiological monitoring training simulator
US11978360B2 (en) 2018-06-29 2024-05-07 Cadwell Laboratories, Inc. Systems and methods for neurophysiological simulation

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