Is the skin conductance algesimeter index influenced by temperature?

Hanne Storm

doi:10.1515/sjpain-2024-0033

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Is the skin conductance algesimeter index influenced by temperature?

Hanne Storm

Published/Copyright: July 3, 2024

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From the journal Scandinavian Journal of Pain Volume 24 Issue 1

It has been questioned if the skin conductance algesimeter index, mirroring skin sympathetic nerve activity, can be influenced by temperature changes in the clinical setting [1,2]. This audit comment is to clarify the interpretation of the finding in the study by Kongsgaard et al. [1], who claim that the increase in the skin conductance algesimeter index is due to the increase in esophageal temperature (the esophageal temperature increased from 36.2 to 38.4°C) during hyperthermic intraperitoneal chemotherapy (HIPEC) perfusion. However, the HIPEC treatment is associated with nociceptive stimuli, and the analgesic level as well as whether epidural works appropriately may be questioned. Kongsgaard et al. treated awake patients with an infusion of lidocaine before the HIPEC treatment. It is well known that peritoneum has nociceptors, particularly in the parietal layer, and the Skin Conductance Algesimeter index is used to assess the response when these nociceptors are activated [3]. The medical device regulation approved Skin Conductance Algesimeter index based on skin conductance peaks per second (Figure 1) [4] has been validated in more than 80 supportive validation studies and 3 doctoral theses [5,6,7] to assess pain and nociceptive stimuli. When the sympathetic nerve activity has been studied in detail, mainly in neurophysiological laboratories, the volunteers have been acclimatized in heat chambers without change in the skin conductance algesimeter index mirrored by changes in galvanic skin resistance (GSR) responses [8]. Then the ambient temperature in the chamber, lasting for minimum 5 min in different temperature levels, increased from 22–24 to 45°C and then decreased to 15°C [7]. Bini et al. concluded that moderate warming from 35 to 40°C induced by ambient temperature changes was not shown to change GSR mirrored by the skin conductance peaks [8].

Figure 1

Skin conductance peaks and GSR responses are mirroring burst in the skin sympathetic nerves assessed by microneurography [4].

For further neurophysiological details, the sympathetic nervous system is divided into two main groups: the sympathetic nerves which activate the smooth muscles of the vessels where epinephrine is the nerve transmitter and the sympathetic nerves to the skin. The sympathetic nerves to the skin with hair are partly controlling our temperature regulation with epinephrine as nerve transmitter, whereas the sympathetic nerves to the skin without hair (the palm and the sole) regulate the emotional sweating with acetyl choline acting on muscarinic receptors [9]. The Skin Conductance Algesimeter index assesses emotional sweating, the skin conductance peaks per second, which is mirroring the bursts in the skin sympathetic nerves as well as the GSR responses (Figure 1): palmary and plantar. Different from the skin conductance peaks per second, the mean skin conductance level (microsiemens – μS) may be influenced by skin temperature when the humidity of the skin increases [2]. The Skin Conductance Algesimeter index has not included the mean skin conductance level (μS) in the index, only skin conductance peaks per second, and is therefore not influenced by temperature changes between 35 and 40°C [8].

From these studies it seems that the increase in the Skin Conductance Algesimeter index that Kongsgaard et al. found during HIPEC treatment is more likely due to nociceptive stimuli than temperature changes. Their statement “Skin Conductance Algesimeter is unreliable to detect increased pain sensation during sudden perioperative temperature changes in adult patients” should be questioned, as well as their anti-nociceptive treatment when the patients have 8 out of 10 according to the skin conductance algesimeter index. If the skin conductance algesimeter index is above 3 in the sedated patients, it clearly indicates need of more anti-nociceptive drugs.

Research ethics: Not applicable.
Informed consent: Not applicable.
Author contributions: The author has accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: I, Professor Emerita Hanne Storm MD. PhD, the Acute Clinic, the Medical Faculty, Oslo University, Oslo, Norway, has been developing the Skin Conductance Algesimeter which is discussed in this publication and I am the CEO and part owner of the company providing the Skin Conductance Algesimeter.
Research funding: None declared.
Data availability: Not applicable.
Artificial intelligence/Machine learning tools: Not applicable.

References

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Received: 2024-04-16

Revised: 2024-06-03

Accepted: 2024-06-03

Published Online: 2024-07-03

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