A MULTI PARAMETER INDEX FOR THE PRESENCE AND SEVERITY OF PAIN

Medasense NOL pain monitor

 

Medasense has developed a patented technology platform to objectively assess the physiological response to pain (nociception), by leveraging composite artificial intelligence algorithms to process and analyzing dozens of pain-related physiological parameters.

The technology combines a non-invasive finger probe incorporating 4 sensors (PPG- photoplethysmograph, GSR- Galvanic Skin Response, Temperature, and Accelerometer).

THE PMD-200 (PAIN MONITORING DEVICE)

Leveraging patented NOL™ technology, the PMD-200™, is a pain monitoring device, that quantifies patients’ physiological response to pain.

By using the PMD-200™ in operating rooms and critical care units, where patients under general anesthesia are unable to communicate their pain, clinicians are able to assess nociception, and titrate analgesic medications – avoiding excessive use or underuse that may result in significant complications.

PMD-200™ is a simple to use, stand alone monitor.

The finger probe continuously acquires physiological signals through 4 sensors.

Dozens of pain-related physiological parameters and derivatives are extracted and computed (Heart rate, Heart rate variability, Pulse wave amplitude, Skin conductance level, Number of skin conductance fluctuations, temperature and more).

Advance machine learning algorithms identify the pain-related pattern and reflect the information on a scale where 0 represents no pain and 100 represents extreme pain – the NOL™ (Nociception Level) Index.

NOL™ provides superior indication of the presence and severity of pain vs. individual parameters (such as changes in Heart rate and Blood pressure).

The easy-to-interpret NOL™ index monitors and grades pain levels objectively, enabling optimal personalized pain treatment.

 

The system consists of a non-invasive finger probe and sensors that acquire multiple physiological signals.

Artificial intelligence algorithms process and analyze dozens of pain-related physiological parameters and derivatives.  The information is converted into a real-time index- NOL™ (Nociception Level) Index, presented on the PMD-200™ bedside monitor.

NOL™ Index varies on a scale where 0 represents no pain (anti nociception) and 100 represents extreme pain (nociception). The NOL™ index delivers accurate, continuous, and non-invasive nociception monitoring.

 

Objective assessment of nociception in anesthetized patients is a key challenge in medicine.

During general anesthesia, a patients’ body reacts to painful stimuli – although it is not consciously recognized. This intraoperative pain can stress the patient’s body and worsen pain after surgery. As the patient cannot communicate it is hard for clinicians to evaluate.

Throughout the surgical procedure, anesthetized patients are continuously monitored for hypnosis and muscle relaxation. Nociception/analgesia are currently assessed by monitoring changes in heart rate (HR), blood pressure (BP), and other indirect parameters which are not sensitive or specific to nociception.

Consequently, the patient may be given insufficient analgesia, which can promote postoperative pain, or excessive analgesia which can result in overdosing and related complications.

Throughout the surgical procedure, anesthetized patients are continuously monitored for hypnosis and muscle relaxation. Nociception/analgesia are currently assessed by monitoring changes in heart rate (HR), blood pressure (BP), and other indirect parameters which are not sensitive or specific to nociception.

 

Abstracts, Poster and Oral Presentations

 

1. Impact of different remifentanil doses on the nociception level index response to intra- operative noxious stimuli
Etienne Renaud-Roy, Pierre-André Stöckle, Olivier Verdonck, Louis-Philippe Fortier, Philippe Richebé.
CAS, Niagara Falls, ON, Canada, June 2017 (pages 6-7)
Euroanaesthesia, Geneva, Switzerland, May 2017 (page 41)

 2. NOL Index performance in patients with beta-blockers
Ruth Edry, Vasile Recea, Yuri Dikust
Euroanaesthesia, Geneva, Switzerland, May 2017 (page 234)

3. Developing a Monitor Process Perspective.
Dr. Ruth Edry – oral presentation at the 2016 Annual Meeting of the Israeli Society of Anesthesiology, December 2016

4. Quantified Analgesic Effect of Intraoperative 50% N2O Inhalation by the NOL and ANI Nociception Indices
Philippe G. Richebe, Elizabeth Decary, Rami Issa, Sarah Maximos, Louis-Philippe Fortier, Olivier Verdonck.
ASA (American Society of Anesthesiologists), Chicago, IL, USA, 2016

5. NOL index variation after standardized nociceptive stimulus decreases with higher doses of remifentanil
Marco Julien, Elizabeth Décary, Rami Issa, Olivier Verdonck, Louis-Philippe Fortier, Philippe Richebé.
EuroAnesthesia – ESA (European Society of Anaesthesiology). London, UK, 2016

6. Ability of the nociception level, a Multiparameter Composite of Autonomic Signals, to detect noxious stimuli during propofol-remifentanil anesthesia
Chris Martini, Martijn Boon, Albert Dahan.
ASA (American Society of Anesthesiologists), San Diego, USA, Oct. 2015

7. The level of nociception (NOL) in thoracotomy patients with and without epidural analgesia
Laurent Bollag, Srdjan Jelacic, Cynthia Wu, Philippe Richebé.
EFIC Pain Congress, Vienna, Austria, Sept. 2015

8. Validation of nociception monitor – The NOL Index
Ruth Edry, Vasile Recea, Yuri Dikust, Daniel I. Sessler.
EuroAnesthesia  – ESA (European Society of Anaesthesiology), Germany, June 2015 (1AP12-6, page 53)

9. Objective assessment of spinal cord stimulation effectiveness on chronic radicular pain
Nir Ben-Israel, Yariv Amos, Noam Racheli, Mark Kliger, Galit Zuckerman, Roi Treister, Elon Eisenberg.
IASP (International Association for the Study of Pain Annual Meeting), Argentina, Oct. 2014

10. Objective measurement of pain levels in patients with radicular pain treated by spinal cord stimulation
Nir Ben-Israel, Yariv Amos, Mark Kliger, Galit Zuckerman, Erica Suzan, Elon Eisenberg.
AAPM (American Academy of Pain Medicine Annual Meeting), AZ, USA,  Mar. 2014

11. Detection of noxious stimuli during general anesthesia using the NOL index for nociception level
Edry Ruth, Kliger Mark, Zuckerman Galit, Racheli Noam, Katz Yeshayahu, Ben-Israel Nir.
EuroAnesthesia – ESA (European Society of Anaesthesiology), Barcelona, Spain, June 2013

12. Non-linear Multi-Parameter Approach for Evaluation of Nociception Level During General Anesthesia
Ben-Israel Nir, Zuckerman Galit, Kliger Mark, Katz Yeshayahu, Edry Ruth.
STA (Society for Technology in Anesthesia), Phoenix, AZ, Jan. 2013
ASA (American Society of Anesthesiologists), Washington DC, Oct. 2012

13. A combination of multiple autonomic parameters, rather than each parameter alone, yields significant differentiation between heat pain intensities
Roi Treister, Mark Kliger, Galit Zuckerman, Itay Goor Aryeh, Elon Eisenberg.
EFIC  Pain Conference, Germany, 2011

14. Toward automatic pain monitoring: Method for classification of pain level based on statistical processing of multiple non-invasive physiological measures
Roi Treister, Mark Kliger, Galit Zuckerman, Itay Goor Aryeh, Elon Eisenberg.
IPA Conference, Israel, 2010

Papers

1. Preliminary intraoperative validation of the NOL Index, a non-invasive nociception monitor
Ruth Edry, Vasile Recea, Yuri Dikust, Daniel I. Sessler.
Anesthesiology July 2016, Vol.125, 193-203

2. Ability of the Nociception Level (NOL), a multiparameter composite of autonomic signals, to detect noxious stimuli during propofol-remifentanil anesthesia
Chris H. Martini, Martijn Boon, Suzanne J. L. Broens, Evelien F. Hekkelman, Lisanne A. Oudhoff, Anna Willemijn Buddeke, Albert Dahan.
Anesthesiology Sept. 2015, Vol.123, 524-534

3. Monitoring the Nociception Level – A Multi-Parameter Approach
Nir Ben-Israel, Mark Kliger, Galit Zuckerman, Yeshayahu Katz, Ruth Edry.
Journal of Clinical Monitoring and Computing (2013) 27: 659

4. Differentiating between heat pain intensities: the combined effect of multiple autonomic parameters
Treister Roi, Kliger Mark, Zuckerman Galit, Itay Goor Aryeh, Eisenberg Elon.
Pain. 2012 Sept.;153(9):1807-14

 

Latest reviews of nociception monitoring technologies

 

1. Digital innovations and emerging technologies for enhanced recovery programmes
Frederic Michard, Tong Joo (TJ) Gan, Henrik Kehlet
Br J Anaesth 2017; 119 (1): 31-39

2. Assessing pain objectively: the use of physiological markers
Rachel Cowen, Maria Stasiowska, Helen Laycock, Carsten Bantel.
Anaesthesia. 2015 July ;70(7):828-47

3. Acute psychosocial stress reduces pain modulation capabilities in healthy men
Geva Nirit, Pruessner Jens, Defrin Ruth.
Pain. 2014 Nov.;155(11):2418-25

4. Multi-parameter autonomic-based pain assessment: More is more?
Marco L. Loggia, Vitaly Napadow.
PAIN 153 (2012) 1779–1780

5. Objective Assessment of Acute Pain
Helen Laycock, Carsten Bantel.
J Anesth Clin Res 2016, 7:6

6. Physiological Signal Processing for Individualized Anti-nociception Management During General Anesthesia: a Review.
Julien De Jonckheere, Vincent Bonhomme, Mathieu Jeanne, Emmanuel Boselli, Matthias Gruenewald, Regis Logier, Philippe Richebé.
Yearb Med Inform. 2015 Aug 13;10(1):95-101