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Researchers continue to look
for brain-based biomarkers

New guidelines advise against the use of brain imaging to diagnose chronic pain

par Lauren Dubinsky , Senior Reporter
A task force of researchers from around the world released new guidelines that recommend against the use of brain imaging to diagnose chronic pain.

With current imaging technology it’s impossible to determine whether a patient is experiencing chronic pain, according to Dr. Karen Davis, pain researcher at the Krembil Research Institute in Toronto, who led the task force. She argued that only the patient can provide that information, since pain is subjective.

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Data from the Institute of Medicine of The National Academies revealed that 100 million Americans suffer from chronic pain. That’s more than the combined incidence of diabetes, coronary heart disease, stroke and cancer.

“Currently, physicians use a variety of approaches to decide on chronic pain treatments that relate to many medical and practical issues,” Davis told HCB News. “The method that is used is effective for some patients but not for many others.”

Physicians take into consideration the severity of the pain, other factors that accompany the pain, such as inflammation, other medical conditions the patient may have that prevent them from using some classes of drugs, the side effects of treatment, and what would be tolerable for the patient.

Recent advancements in brain imaging have led to a greater understanding of acute and chronic pain. That prompted a search for brain-based biomarkers for pain in order to offer patients more personalized treatment options.

Brain imaging is also in high demand among the legal community for use as a “lie detector” for chronic pain. Davis refers to that practice as inappropriate and unethical because pain varies between individuals and even within an individual at different times.

The new guidelines, which are published in the journal Nature Review: Neurology, state that any brain-based biomarkers should only be used as an adjunct to subjective reports of pain even if testing is improved and valid protocols are developed.

Davis and her team are working toward finding biomarkers for chronic pain to help provide more personalized treatment. The task force hopes the guidelines will be used by health care systems, governments, and legal policy makers as a blueprint for moving forward with research.

“Through brain imaging, we may be able to find particular features of the brain in some patients that are present when a particular treatment is effective, and other features that are present when that treatment is not,” said Davis. “Then, we would be able to match the patient to treatment.”

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