{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T18:07:11Z","timestamp":1778954831189,"version":"3.51.4"},"reference-count":82,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T00:00:00Z","timestamp":1633651200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japan Society for the Promotion of Science (JSPS) KAKENHI","award":["JP17K19818"],"award-info":[{"award-number":["JP17K19818"]}]},{"name":"Japan Society for the Promotion of Science (JSPS) KAKENHI","award":["JP20K19132"],"award-info":[{"award-number":["JP20K19132"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recently, event-related potentials (ERPs) evoked by skin puncture, commonly used for blood sampling, have received attention as a pain assessment tool in neonates. However, their latency appears to be far shorter than the latency of ERPs evoked by intraepidermal electrical stimulation (IES), which selectively activates nociceptive A\u03b4 and C fibers. To clarify this important issue, we examined whether ERPs evoked by skin puncture appropriately reflect central nociceptive processing, as is the case with IES.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In Experiment 1, we recorded evoked potentials to the click sound produced by a lance device (click-only), lance stimulation with the click sound (click+lance), or lance stimulation with white noise (WN+lance) in eight healthy adults to investigate the effect of the click sound on the ERP evoked by skin puncture. In Experiment 2, we tested 18 heathy adults and recorded evoked potentials to shallow lance stimulation (SL) with a blade that did not reach the dermis (0.1 mm insertion depth); normal lance stimulation (CL) (1 mm depth); transcutaneous electrical stimulation (ES), which mainly activates A\u03b2 fibers; and IES, which selectively activates A\u03b4 fibers when low stimulation current intensities are applied. White noise was continuously presented during the experiments. The stimulations were applied to the hand dorsum. In the SL, the lance device did not touch the skin and the blade was inserted to a depth of 0.1 mm into the epidermis, where the free nerve endings of A\u03b4 fibers are located, which minimized the tactile sensation caused by the device touching the skin and the activation of A\u03b2 fibers by the blade reaching the dermis. In the CL, as in clinical use, the lance device touched the skin and the blade reached a depth of 1 mm from the skin surface,\n                      <jats:italic>i.e.<\/jats:italic>\n                      , the depth of the dermis at which the A\u03b2 fibers are located.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The ERP N2 latencies for click-only (122 \u00b1\u00a02.9 ms) and click+lance (121 \u00b1\u00a06.5 ms) were significantly shorter than that for WN+lance (154 \u00b1\u00a07.1 ms). The ERP P2 latency for click-only (191 \u00b1\u00a011.3 ms) was significantly shorter than those for click+lance (249 \u00b1\u00a018.6 ms) and WN+lance (253 \u00b1\u00a011.2 ms). This suggests that the click sound shortens the N2 latency of the ERP evoked by skin puncture. The ERP N2 latencies for SL, CL, ES, and IES were 146 \u00b1\u00a08.3, 149 \u00b1\u00a09.9, 148 \u00b1\u00a013.1, and 197\u00a0\u00b1\u00a021.2\u00a0ms, respectively. The ERP P2 latencies were 250 \u00b1\u00a018.2, 251 \u00b1\u00a014.1, 237 \u00b1\u00a026.3, and 294\u00a0\u00b1\u00a030.0 ms, respectively. The ERP latency for SL was significantly shorter than that for IES and was similar to that for ES. This suggests that the penetration force generated by the blade of the lance device activates the A\u03b2 fibers, consequently shortening the ERP latency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lance ERP may reflect the activation of A\u03b2 fibers rather than A\u03b4 fibers. A pain index that correctly and reliably reflects nociceptive processing must be developed to improve pain assessment and management in neonates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.12250","type":"journal-article","created":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T06:35:40Z","timestamp":1633674940000},"page":"e12250","source":"Crossref","is-referenced-by-count":4,"title":["Event-related potentials evoked by skin puncture reflect activation of A\u03b2 fibers: comparison with intraepidermal and transcutaneous electrical stimulations"],"prefix":"10.7717","volume":"9","author":[{"given":"Yui","family":"Shiroshita","sequence":"first","affiliation":[{"name":"Department of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hikari","family":"Kirimoto","sequence":"additional","affiliation":[{"name":"Department of Sensorimotor 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