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BJA Advance Access published online on February 6, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh097
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted June 29, 2003

Clinical Investigation

Testing of a new pneumatic device to cause pain in humans

H. M. Schubert 1*, I. H. Lorenz 2, F. Zschiegner 2, C. Kremser 3, M. Hohlrieder 2, M. Biebl 4, C. Kolbitsch 2, P. L. Moser 5

1 Department of Trauma Surgery and Sports Medicine, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
2 Department of Anaesthesia and Intensive Care Medicine, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
3 Department of Magnetic Resonance Imaging, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
4 Department of Vascular Surgery, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
5 Department of Pathology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria

* To whom correspondence should be addressed. E-mail: heinrich.schubert{at}uibk.ac.at.


  Abstract

Background. Surgical pain typically combines superficial and deep pain. We wished to generate pain that resembled surgical pain, reliably and reproducibly, in volunteers.

Methods. We constructed a computer-controlled pneumatic device to apply pressure to the anterior tibia. The reproducibility of the pain was tested by rating the pressure that caused pain rated 4-5 on a visual analogue scale (VAS) on days 0, 7, and 24 in 10 volunteers. The effect of remifentanil (0.025, 0.05, 0.075, and 0.1 µg kg-1 min-1) on pain tolerance in another set of volunteers (n=11) was used as an indirect measure of the reliability of pain production.

Results. The pressure needed (0.7 (0.3) to 0.9 (0.4) atm (mean (SD)) to induce pain rated 4-5 (VAS) did not vary, showing long-term reproducibility of the method. When pressure was applied to cause increasing pain in volunteers (n=11) 0.05 µg kg-1 min-1 remifentanil increased pain tolerance by 50%. An approximate doubling of the dose (0.1 µg kg-1 min-1) increased pain tolerance significantly more. The linear logarithmic dose-effect relationship shows that the device causes pain reliably, and this can be reduced with opioid treatment.

Conclusion. This pneumatic device can apply pain reliably and reproducibly.

Br J Anaesth 2004

Keywords: Keywords: analgesics opioid, remifentanil; pain, experimental; pain, stimulus; pain, tolerance; volunteers


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