IMPACT-Instrument to Measure Pain and Assess Correlation to Treatment. Create a smartphone pupillometry to objectively determine the presence of acute pain, evaluate opioid as the treatment for pain. - PROJECT SUMMARY/ABSTRACT
While patient self-report of pain is currently the gold standard of pain measurement, accurate
self-reports of pain may not be feasible in critically ill patients who are sedated and intubated,
unconscious patients, or patients who are unable to verbally communicate their pain. Current
research has shown that pupillary dilation (PD) is a reliable indicator of acute pain, and that
measurement of pupil size changes may be useful in determining the intensity of pain
experienced as well as the efficacy of an analgesia. There is also research demonstrating the
value of pupillary unrest under ambient light (PUAL) as an objective marker of sensitivity to
opioids, and the use of facial expression analysis to detect pain. IMPACT proposes pupillometry
with a proprietary algorithm to measure both PD and PUAL, and facial expression analysis
using computer vision. Through IMPACT, Benten proposes to provide clinicians with a device
that helps them objectively determine the presence or absence of pain, assess opioid efficacy,
and assist in deciding whether opioids should be the treatment of choice for a patient.
The utimate goal of IMPACT is to revolutionize measurement and management of pain. The
novel approach of measuring PD, PUAL, and facial expressions will help eliminate subjectivity in
the diagnosis of pain, and avoid over-administration of opioids or administration of opioids to
patients who are not suitable candidates for opioid treatment. IMPACT will demonstrate the
feasibility of using pupil size changes and facial expressions to guide the diagnosis and
treatment of pain, and compare results obtained to pain scores reported by patients on the
NRS, to assess accuracy of pain measurement and effectiveness in pain alleviation.
IMPACT will be designed and developed to serve the needs of patients who experience severe
pain, and provide them with pain relief, through objection clinical decision-making. The aims of
IMPACT are as follows:
1) Phase I Specific Aims: Develop IMPACT prototype and conduct a validity test with 25
subjects, to demonstrate the efficacy and validity of IMPACT versus a commercial
pupilometer, and
2) Conduct a feasibility pilot test of IMPACT with 20 patients in the post-anesthesia care unit
(PACU) of Christiana Care Health System (CCHS), to demonstrate the feasibility of IMPACT
in determining pain and assessing opioid efficacy.
The short-term impact will be an improvement in pain detection, and more objective clinical
decision making regarding opioid administration. The long-term impact will be a decrease in the
misuse of opioid medication, and the facilitation of objective measurement of symptoms in
clinical settings.
