i-Pain System Fuzzy pain intensity (FPI) inde x applied in modelling of acute pain via a patient-controlled a nalgesia device
i-Pain System
Fuzzy pain intensity (FPI) index applied in modelling of acute pain via a pati
ent-controlled analgesia device
Multifaceted Model of Pain Components
NociceptionNociception
PainPain
SufferingSuffering
Pain BehaviorPain Behavior
AcuteAcute
ChronicChronic
Four Dimensions of PainFour Dimensions of Pain Four Dimensions of PainFour Dimensions of Pain
Sensory-discriminative Sensory-discriminative Motivational-affectiveMotivational-affective Cognitive-evaluativeCognitive-evaluative Social-behavioralSocial-behavioral
Problem: Detecting pain Subjective & no direct measurement Clinical: Visual Analogue Scales (VAS) Numerical Rating Scales (NRS) Verbal Rating Scales (VRS) Questionnaire
Pain Intensity ScalesPain Intensity Scales
DescriptiveDescriptive pain scalespain scales
NoNopainpain
MildMild ModerateModerate SevereSevere WorstWorstpossiblepossiblepainpain
Numeric pain scalesNumeric pain scales
NoNopainpain
11 22 33 44 55 66 77 88 99
1010
WorstWorstpossiblepossiblepainpain
00
Visual analog scale (VAS)Visual analog scale (VAS)
NoNopainpain
Pain as worst Pain as worst as it could beas it could be
00 1010
疼痛量尺 ( 正面 )
無法忍受完全不痛
正面
疼痛強度
完全不痛
輕微痛
非常痛
無法忍受
疼痛種類
酸脹 痠軟
緊繃 抽筋
冰冷 灼熱
放電 切割
麻癢 撕裂
VAS
VRS
疼痛量尺 ( 反面 )疼痛量尺 ( 反面 )
完全不痛無法忍受
反面
Evaluation: face scales
McGill Pain Questionnaire 4 groups of
descriptors: Sensory: 1-10 Affective: 11-15 Evaluative: 16 Miscellaneous: 17-20
Pain rating index (PRI) Present pain intensity (PPI):
0-5
The Disadvantage of these methods: Static Pain (not Dynamic Pain) Maybe, the VAS values are similar but the efforts are totally different Time Consuming The On-line Analyzing Pain is impossible
Pain has become the “Fifth vital Sign”
Patient’s chart : BP, HR, RR, and T
The functions of the PCA• Administer small bolus doses of Pain-control drugs• At fixed intervals• Controlled by the patient with the push of a button
bolusinfusion pain scores
(between 0~10)
Button-pressing profile
PCA PatientVASNRSVRS
controlled by patient
(a)
FPI index(between0~10)
Fuzzy ModelAlgorithm
PainPattern
PCA PatientButton-pressing
profile
pain
BPSPZP
(b)Figure1. Block diagram of modelling pain system to interpret the pain measurement (a) Conventional PCA system; (b) PCA+FPI system
i-Pain System:i-Pain System: Information,Information, Intelligent, Intelligent, Sound similar to feeling painSound similar to feeling pain
A Hierarchical Level of i-Pain System
Internet
Drug Demand by Patient
Data in Computer
PCA Pain Database
Data Mining
D/D Ratio Mean Drug C.
Pain Pattern
FPI
PCA PDA
1st Level
2nd Level
3rd Level
4th Level
Clinical DataAcquisition
Clinical DataAnalysis
PCA病患自控止痛系統 資料接收 病患基本資料 檢視及輸出 調劑紀錄 選項 副作用 巡房紀錄 上傳至 Server (via Internet)
The i-Pain System Designed in Post-OP:The i-Pain System Designed in Post-OP:
病患基本資料
檢視及輸出
調劑紀錄
選項
副作用
巡房紀錄
BP (Big Pain or Severe Pain): Two buttons are pushed at least
during 4 lockout intervalsSP (Small Pain or Little Pain): A button is pushed during 4 lockout intervalsZP: (Zero Pain or No Pain): No any button is pushed during 4 lockout intervals
.
The definition of BP, SP, and ZP
(a) Pain Pattern:
75% Overlapped Calculation
For 4 Lockout and Overlap : BP 、 BP 、 BP 、BP
BP = 100% 、 SP=0% 、 ZP=0%
=Demand
=Delivery
Delivery : 1mg
=Demand
=Delivery
For 4Lockout and Overlap : SP 、 ZP 、 SP 、BP
BP = 25% 、 SP=50% 、 ZP=25%
• rules of thumb • imprecise information• personal rules
Anaesthetists Use:
Why Fuzzy Logic in i-Pain System ?
IF Pain_intensity is Big_painTHEN set the Morphine infusion rate to a HIGH LEVEL
Big Pain Small PainZero Pain
Fuzzy System
FPI index
Fuzzy Pain Intensity (FPI) Index
Input Membership Function (9 Levels)
Output Membership Function (11 Levels)
Membership Function:
Fuzzy Rules: 36
)()(
36
1
)()(
36
1
)()(
36
1
iiZPi
ZP
iiSPi
SP
iiBPi
BP
XXR
XXR
XXR
'''
'
'
'
ZPSPBPFPII
ZPZPZP
SPSPSP
BPBPBP
XXXX
RXX
RXX
RXX
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Fuzzy Inference Engine:
Fuzzy Defuzzification:
Center of area (COA):
I
Mn Un
Mn
n
n
( )1
1
Where M is the membership function; U is the universe of discourse; n is the number of rules.
Delivery
Demand(b) PCA D/D Ratio:
TimeTotal
doseDeliveryTotal
_
__
(c) PCA Mean Drug Consumption:
=Delivery
=Demand
Demand/Delivery Ratio : Delivery=4 , Demand=7 ; Demand/Delivery Ratio=7/4=1.75
Patients and Results:
(a) Drugs: Morphine , Morphine + Keto for 1 & 2 ml
Patient Male Female
Morphine-1ml dose 258 111 147
Morphine-2ml dose 234 105 129
Morphine + Keto-1ml dose 129 49 80
Morphine + Keto-2ml dose 80 26 54
AgeLockout
Time (min)
Height (cm)
Weight (kg)
Days
Morphine-1ml dose
57.84±
17.327.88±2.1
158.46±
13.99
60.89±
11.475.6±2.63
Morphine-2ml dose
53.41±
15.79
9.29±1.66
161.24± 8.6
68.23±
49.95
5.06±2.35
Morphine + Keto-1ml dose
57.34±
15.59
6.92±1.69
157.88± 8.19
60.09±
10.69
5.43±2.44
Morphine + Keto-2ml dose
41.27±
13.379.4±1.46
153.3± 35.73
65.43±
12.55
4.38±2.52
(b) Drugs: Morphine 1 ml or Morphine 2 ml with
Different lockout time (6 or 10 min)
Patient Male Female
Morphine-1ml dose (6min) 138 57 81
Morphine-1ml dose (10 min) 117 50 67
Morphine-2ml dose (6min) 43 26 17
Morphine-2ml dose (10min) 190 79 111
AgeLockout
Time (min)
Height (cm)
Weight (kg)
Days
Morphine-1ml dose
54.64±
14.496
158.84±
16.94
60.02±
11.82
5.52±2.36
Morphine-1ml dose
62.57±
18.2110
158.27±
8.91
59.44±
10.82
5.80±2.87
Morphine-2ml dose
49.00±
10.336
164.88±
8.91
65.53±
10.27
5.56±2.68
Morphine-2ml dose
54.30±
16.6810
160.6±8.27
65.82±
12.55
4.87±2.14
Surgical Types Dosage Pt. No.
Upper Abdomen
Morphine (1ml)
54
Morphine (2ml)
52
Lower Abdomen
Morphine (1ml)
80
Morphine (2ml)
43
SpineMorphine
(1ml)28
Morphine (2ml)
17
ExtremityMorphine
(1ml)64
Morphine (2ml)
70
(c) Different Surgical Operations
A Hierarchical Level of i-Pain System
Internet
Drug Demand by Patient
Data in Computer
PCA Pain Database
Data Mining
D/D Ratio Mean Drug C.
Pain Pattern
FPI
PCA PDA
1st Level
2nd Level
3rd Level
4th Level
Clinical DataAcquisition
Clinical DataAnalysis
PDA for Interviewing Patients Applied in the assessment of
postoperative pain
The Advantages of Using PDA for
Interviewing Patient
Small , Light , Portable High Technology 、 Fancy Search and save data easily Data can be shown in Figures
Pain Location : Displaying an anterior and posterior view of the bodyVAS Score: Displaying an VAS image to the patient
Data Communications:
USBRS232
IrDA
RF
PCA
PDA
Computer
PDA
PC
PCA
PDA as a Messenger for Data Collection
Conventional Interviewing System
(Paper Pain Diary)Current Interviewing System
PDA Interviewing System(Electronic Pain Diary)
Recent works: Fuzzy D/D Ratio Index (2nd Dimen.)
Mining the Web Information for Actionable Knowledge (Drug Amount, Different Drug, Lockout Time, Timing After OP)
The Real Time of FP Index
RS-232
PCA
Receive Tablet PC
Future works:
Acute Pain Center for Multicenter Research Share these technologies, Information & Intelligence for this area of research
Data Mining & Warehousing Chronic Pain (Ex. Cancer Pain)