Pullilometry not effective method to assess pain in the emergency department

Pain management is crucial in Emergency Department(ED) patients. Research over the past several decades has led to significant improvement in the recognition and treatment of pain among all age groups. However, despite significant advances in the understanding of the mechanisms of pain much is yet to be known.

Popularly two dynamic pupillary measures are used in conscious subjects after a surgical procedure that are known to correlate to the magnitude of ongoing pain. However a recent study conducted by Belgian investigators suggests clinicians should not rely on pupil diameter or its response to light to assess pain levels among emergency department (ED) patients, and it is reported in the European Journal of Pain.

Charles Gregoire and team aimed to test the ability of dynamic measures derived from pupillometry to evaluate pain intensity in conscious adult patients admitted to the ED. The study was a prospective, interventional, single-centre study performed between August 2021 and January 2022 (NCT05019898). An assessment of self-reported pain intensity was performed on ED admission by the triage nurse using a numeric rating scale (NRS). This was followed by two dynamic measures derived from pupillometry that were previously correlated with pain perception: the pupillary unrest under ambient light (PUAL) and the pupillary light reflex (PLR).