Neuroimaging Should Not Be Used to Confirm Chronic Pain

Findings from brain imaging should not be used to judge whether a patient has chronic pain, according to a presidential task force of the International Association for the Study of Pain (IASP).

Although self-reporting is currently the gold standard for the assessment of pain, brain imaging, including functional MRI, PET, and EEG, is considered to have the potential for diagnosis, prognostication, and prediction of treatment outcomes in patients with chronic pain.

For this reason, a presidential task force of the IASP sought to examine the effectiveness of brain imaging in the diagnosis of chronic pain, as well as the ethical and legal implications of its use for this purpose.

The task force noted patient variability, specificity, reverse inference, and technical and statistical challenges as the major challenges in imaging chronic pain.

They also provided 7 criteria for establishing valid neuroimaging protocols, including a precise definition of a pain neuromarker, applicability of the neuromarker to individuals, and validated methodological procedures during testing.

“In our view, current brain-based measures fall short of the requisite standards for legal proceedings, but we do encourage their use for understanding brain mechanisms that underlie pain, factors that lead to persistence of pain, and targets in the brain for safe and effective pain control,” the task force concluded.

—Michael Potts

Reference:

Davis KD, Flor H, Greely HT, et al. Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations [published online September 8, 2017]. Nature Reviews Neurology. doi:10.1038/nrneurol.2017.122.