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Feeling Your Pain, And Measuring It Objectively

September 22, 2011
Written by: , Filed in: Diagnostic Imaging, Neuroradiology
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Don’t bother to tell us whether it hurts. We know.

Researchers affiliated with Stanford University have moved a step closer to being able to say that to patients. Using functional MRI and a support vector machine (SVM; a computer model that assigns inputs to one of two possible categories—in this case, pain or nonpain—and that is capable of learning and adapting as it receives more data), they interpreted brain activity. They were able to tell with 81 percent accuracy whether a stimulus was painful.

OK, that’s not exactly a home run. But it’s a start. As the researchers summarized in an article published last week in the open-access journal PLoS ONE:

We are still very far from a physiology-based pain assessment tool that could be used in clinical, forensic, and other applied settings. However, we see the goal of an accurate, valid surrogate for self-reported pain as both attainable and worthy of effort.

Why bother developing an objective measure of pain when patients are perfectly capable of, and usually enthusiastic about, informing a health-care worker when they are in pain?

Well, some of them actually aren’t, because of injury or dementia, for example. Others may exaggerate the intensity of their pain—such as someone trying to cheat an insurance company.

So the Stanford researchers tested eight people, measuring the subjects’ brain activity as they reacted to heat probes at both painful and nonpainful intensities. That exercise served to teach the SVM how to differentiate between pain and nonpain. The researchers then applied their probes to 16 new subjects, achieving an 81 percent correlation between brain activity indications of pain as flagged by the SVM and actual pain as reported by the subjects.

The researchers discovered that their pain detector worked best when it assessed activity across the entire brain rather than focusing on specific areas, suggesting (not surprisingly) that the body’s sensation of and reaction to pain is complex.

Still, the study seems promising. Sean Mackey, MD, PhD, the corresponding author and a pain researcher and anesthesiologist at Stanford School of Medicine, noted that despite that complexity, the study found that pain has some features that lend themselves to objective measurement:

There are some commonalities in these neural signatures from one person to another.

 

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Related seminar: Neuro & Musculoskeletal Imaging

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