The consistency in locating nociceptive stimuli applied to the lumbar region

Barbero, Marco and Trenta, Davide and Gallace, Alberto and Falla, Deborah and Cescon, Corrado and Corbetta, Davide (2018) The consistency in locating nociceptive stimuli applied to the lumbar region. In: ISEK 2018 Congress - XXII Congress of the International Society of Electrophysiology and Kinesiology, 29th June - 1st July 2018, Dublin, Ireland.

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BACKGROUND AND AIM: Digital body charts are used to assess the pain experience in people with acute and chronic pain. Patients are asked to report their pain by shading a human body template on a digital tablet. The aim of this study was to investigate whether healthy volunteers could consistently locate on a digital body chart, nociceptive stimuli induced in the lumbar region. Methods: Thirty-six healthy volunteers participated in the study. A standardised grid of four rows and five columns was drawn over the participants’ lumbar region. Six circular electrodes, connected to a constant current stimulator, were applied at points on the grid: one on the cross between column three and row four, five in the remaining crosses by means of a stratified randomisation procedure (i.e. one electrode for each columns). Additionally, six electrodes not connect to the electrical stimulator were distributed over the remaining crosses (Fig.1A). Volunteers were blinded to the electrode locations. Eight painful electrocutaneous stimuli were randomly delivered for each connected electrode. Participants were instructed to draw where they perceived each painful stimulation using a digital body chart on a tablet (Apple iPad Pro, 12.9, US) with a stylus pen. The body chart was centred on a canvas 768x1024 pixels (pxl), and pain location was defined by X and Y coordinates. For each stimulated electrode, the barycentre was computed for the eight locations reported on the digital body chart. The consistency in reporting the location of each painful stimulation was described using three variables: the standard deviation of the X coordinates (X-sd), the standard deviation of the Y coordinates (Y-sd) and the mean distance from the barycentre (D-bar) (Fig 1B). Results: The median(IQR) X-sd was 10.3(9.1) pxl, the median(IQR) Y-sd was 18.2(12.9) pxl and the median(IQR) D-bar was 18.3(10.5) pxl. X-sd in column three was significantly lower than in column one, two, and four. No significant difference was found between column and rows for Y-sd. No significant difference was found between column and rows for D-bar, except between row three and four (Fig1C). Conclusion: The consistency in reporting the location of nociceptive stimuli to the lumbar region in healthy volunteers is higher in the horizontal direction than in the vertical direction. As expected the highest consistency was observed along the midline of the body (i.e. column three) for the horizontal direction. The median variability in locating the nociceptive stimulations on the digital body chart were 2.5 mm for the horizontal direction and 4.5 mm for the vertical direction. Additionally, the D-bar corresponded to 4.5 mm. The consistency in locating the nociceptive stimuli, considering the physical dimension of the digital body chart (i.e. 262x197 mm), appear to be adequate for pain location assessment. The acquired data will serve as a foundation for further investigations in patients with chronic low back pain.

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