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Correlation Between Salivary α-Amylase Activity and Pain Scale in Patients With Chronic Pain
  1. Shyuichi Shirasaki, M.D.,
  2. Hitomi Fujii, M.D.,
  3. Miho Takahashi, M.D.,
  4. Tetsumi Sato, M.D.,
  5. Masako Ebina, M.D.,
  6. Yuka Noto, Ph.D. and
  7. Kazuyoshi Hirota, M.D., F.R.C.A.
  1. Department of Anesthesiology, Caress Alliance Tenshi Hospital, Sapporo, Japan
  2. Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki, Japan
  3. Department of Nursing, University of Hirosaki School of Health Sciences, Hirosaki, Japan.
  1. Reprint requests: Kazuyoshi Hirota, M.D., F.R.C.A., Department of Anesthesiology, Hirosaki University School of Medicine, Hirosaki 036-8563, Japan. E-mail: hirotak{at}


Background and Objectives: The visual analog scale (VAS) is commonly used to assess pain intensity. However, the VAS is of limited value if patients fail to reliably report. Objective assessments are therefore clearly preferable. Previous reports suggest that elevated salivary α-amylase may reflect increased physical stress. There is a close association between salivary α-amylase and plasma norepinephrine under stressful physical conditions. In this study, we have determined the usefulness of a portable salivary α-amylase analyzer as an objective biomarker of stress.

Methods: Thirty patients (male/female = 15/15, age: 60.5 ± 15.3 years) with chronic low back or leg pain (pain (+) group) and 20 pain-free control patients undergoing elective surgery under general anesthesia with epidural analgesia (pain (−) group) were recruited. Patients received epidural block with 5 to 10 mL 1% lidocaine. VAS, blood pressure, and heart rates were assessed before and 30 and 45 minutes after the epidural block. Salivary α-amylase was simultaneously measured using a portable analyzer. The relationship between the VAS and salivary α-amylase in chronic pain patients was assessed.

Results: After the epidural block both heart rate and systolic blood pressure decreased by ˜8%. In the pain (+) group, the epidural block markedly decreased the VAS pain scale and salivary α-amylase from 56 ± 22 to 19 ± 16 mm (P < .01) and from 82 ± 48 to 45 ± 28 U/mL (P < .01), respectively, with a significant correlation between the 2 measures (r = 0.561, P < .01). In contrast, salivary α-amylase did not change significantly in the pain (−) group.

Conclusions: Because there was a significant correlation between VAS pain scale and salivary α-amylase, we suggest that this biomarker may be a good index for the objective assessment of pain intensity. In addition, a simple to use portable analyzer may be useful for such assessment.

  • Pain scale
  • Salivary α-amylase activity
  • Epidural block

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