Differentiating between heat pain intensities: The combined effect of multiple autonomic parameters

Roi Treister, Mark Kliger, Galit Zuckerman, Itay Goor Aryeh, Elon Eisenberg

Research output: Contribution to journalArticlepeer-review


Although it is well known that pain induces changes in autonomic parameters, the extent to which these changes correlate with the experience of pain is under debate. The aim of the present study was to compare a combination of multiple autonomic parameters and each parameter alone in their ability to differentiate among 4 categories of pain intensity. Tonic heat stimuli (1 minute) were individually adjusted to induce no pain, low, medium, and high pain in 45 healthy volunteers. Electrocardiogram, photoplethysmogram, and galvanic skin response were recorded, and the following parameters were calculated: heart rate; heart rate variability - high frequency (0.15 to 0.4 Hz) spectral power; skin conductance level; number of skin conduction fluctuations; and photoplethysmographic pulse wave amplitude. A combination of parameters was created by fitting an ordinal cumulative logit model to the data and using linear coefficients of the model. Friedman test with post-hoc Wilcoxon test were used to compare between pain intensity categories for every parameter alone and for their linear combination. All of the parameters successfully differentiated between no pain and all other pain categories. However, none of the parameters differentiated between all 3 pain categories (i.e., low and medium; medium and high; low and high). In contrast, the linear combination of parameters significantly differentiated not only between pain and no pain, but also between all pain categories (P <.001 to.02). These results suggest that multiparameter approaches should be further investigated to make progress toward reliable autonomic-based pain assessment.

Original languageEnglish
Pages (from-to)1807-1814
Number of pages8
Issue number9
StatePublished - Sep 2012
Externally publishedYes

Bibliographical note

Funding Information:
The study was funded by Medasense Biometrics Ltd. Dr. Kliger, Ms. Zuckerman, and Dr. Goor-Aryeh are employees of Medasense Biometrics. Prof. Eisenberg serves on the advisory board of Medasense Biometrics Ltd.


  • Electrocardiogram
  • Experimental pain
  • Galvanic skin response
  • Heat pain
  • Photoplethysmogram

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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