Cortical potentials related to assessment of pain intensity with visual analogue scale (VAS)

• Published in: Clinical neurophysiology Vol. 113; no. 7; pp. 1013 - 1024
• Main Authors: Kanda, Masutaro, Matsuhashi, Masao, Sawamoto, Nobukatsu, Oga, Tatsuhide, Mima, Tatsuya, Nagamine, Takashi, Shibasaki, Hiroshi
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.07.2002; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Cerebral Cortex - physiology; CO 2 laser stimulation; Electrodiagnosis. Electric activity recording; Electroencephalography; Electromyography; Event-related potentials (ERPs); Evoked Potentials, Somatosensory - physiology; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Lasers; Male; Medical sciences; Motor Skills - physiology; Nervous system; Pain - physiopathology; Pain intensity assessment; Pain Measurement; Pain-related somatosensory evoked potentials (pain SEPs); Psychophysics; Visual analogue scale (VAS); Pain-related somatosensory evoked potentials (pain SEPs); Visual analogue scale (VAS); CO 2 laser stimulation; Event-related potentials (ERPs); Pain intensity assessment; Human; Noxious stimulus; Evaluation scale; Visual analogue scale; Central nervous system; Stimulus intensity; CO; Somatosensory cortex; Electrodiagnosis; Pain; laser; Somesthetic pathway; Topography; Somatosensory evoked potential; Event evoked potential; Brain (vertebrata)
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/S1388-2457(02)00125-6

Objectives: To elucidate brain mechanisms underlying the psychophysical processes to measure pain intensity, pain-related somatosensory evoked potentials (pain SEPs) following painful CO 2 laser stimulation were studied while employing a task to measure intensity of pain on a visual analogue scale (VAS). Methods: In 12 healthy subjects, 3 kinds of CO 2 laser stimuli, different in intensity as determined by irradiation duration of 40, 60 and 80 ms, were randomly delivered to the left hand dorsum at an irregular interval of 4–6 s. The subject was requested to assess the intensity of each pain stimulus and point to the VAS scale by moving a pointer held with the right hand according to the subjective feeling of pain sensation (pain intensity assessment (PIA) condition). For the control condition, the subject moved the pointer to the midpoint of the VAS line irrespective of the pain intensity (control motor task condition). Electroencephalograms were recorded from 21 scalp electrodes, referenced to the linked earlobes, and were averaged time-locked to the stimulus onset for each stimulus duration as well as for each task condition. Results: The VAS scores were 2.8±0.5/10 for the stimulus of 40 ms duration, 4.8±0.8/10 for 60 ms and 6.1±0.9/10 for 80 ms, and showed a highly significant positive correlation with the stimulus duration. Following the early components of pain SEPs which were affected by stimulus duration but not modulated by task conditions, a surface-positive peak at latency of 612–642 ms was identified exclusively under the PIA condition regardless of the stimulus intensity and was called ‘intensity assessment-related potential (IAP)’. The IAP was maximal at the midline parietal area and symmetrically distributed over the scalp. Neither latency nor amplitude of the IAP was significantly different among the 3 different stimulus intensities. Conclusions: IAP is an event-related potential (ERP) associated with assessment of pain intensity but not influenced by pain intensity itself. From its scalp distribution, it can be assumed that the assessment of pain intensity involves multiple areas in both hemispheres.