The PainMonitor Index

The PainMonitor index – Skin Conductance Algesimeter indices mirror how often the skin sympathetic nerves are firing to tailor the need of analgesia during pain, nociceptive stimuli and withdrawal symptoms.

  • The Skin Conductance Algesimeter index reacts within seconds, has low variation between individuals when they are at the same emotional stress level, is not influenced from changes in blood circulation or medications acting on the blood circulation due to the nerve transmittors involved (acetylcholine acts on muscarinic recaptors.
  • Meets challenges form the opioid epidemic. The hypotensive effect of alfa-2 agonists and the blood circulatory effect of beta-blockers do not influence the Algesimeter.
  • Indices for all age groups from 23 weeks of gestational age.

Main advantages:

The PainMonitor device, the Skin Conductance Algesimeter, has indices to tailor the level of analgesia during intensive care, postoperatively, and anaesthesia in all age groups as well for preterm infants from 23 weeks of gestational age (the device is not influenced from gestational and postnatal age). The Skin Conductance Algesimeter is not influenced by temperature (22 °C – 42 °C), general hypoxia, hypo- and hyper-volume, beta-blockers, epinephrines, and the hypotensive effect of alfa-2 agonists, as well as neuromuscular blockers (neuromuscular blockers act on nicotine receptors). This is due to the fact that skin sympathetic nerves, mirrored by skin conductance changes, have acetyl-choline acting on muscarinic receptors (atropine does not influence in clinical doses).

The Skin Conductance Algesimeter therefore meets the need to tailor analgesia when medications with hypotensive and blood circulatory effect, like alfa-2 agonists and beta-blockers, are used to reduce the level of opioids.

The Physiology:

The Skin Sympathetic Nerves (assessed by micro-neurography) are the only sympathetic nerves in the body where acetylcholine acts on muscarinic receptors. How often these nerves are firing, number of bursts per time unit, is directly mirrored in real time by the Skin Conductance Algesimeter index which is based on skin conductance peaks per sec:

The Skin Conductance Algesimeter index before, during and after painful events, the skin conductance peaks per second increases (mirroring increased activity in the skin sympathetic nerves) during painful stimuli. The colour coded index goes to orange or red if the patient needs more analgesia.

(Storm H. Skin conductance activity and the stress response from heel stick in premature infants. Archives of Disease in Childhood 2000;83(2):F143-F147.).

The Skin Conductance Algesimeter index is based on the number of burst in the skin sympathetic nerves, mirrored by the skin conductance peaks per second, when assessing pain and nociceptive stimuli as well as withdrawal symptoms.

The existing device:

It is possible to choose among different applications.

The Med-Storm software can be installed on the PhilipsMX patient monitor with iPC, the Philips Intellevue, the Mindray patient monitor with iView and the bridge-solution (in process), and works on the Draeger Explorer (USB ports as it is basically a flat panel PC), and some Nihon Koden patient monitors.

A standalone monitor is also available: