A task force consisting of researchers from around the world and led by a scientist at the Krembil Research Institute in Toronto has released a set of recommendations that advise against the use of brain imaging as a test for chronic pain.
“It’s not possible at this point in time to say with any degree of certainty that a person does or does not have chronic pain based on brain imaging,” said Dr. Karen Davis, Head, Division of Brain, Imaging and Behaviour-Systems Neuroscience at the Krembil Research Institute at UHN .
“The only way to truly know if someone is in pain is if they tell you because pain is subjective and it is a complex experience. No brain scan can do that.”
The recommendations of the task force – which consisted of clinicians, brain imaging researchers as well as experts in functional magnetic resonance imaging (fMRI), neuroethics and law – were published today in the journal Nature Review: Neurology in a paper titled “Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations.”
I’ve added the paper’s PubMed abstract below this article.
as brain imaging measures become more acceptable for directing personalized pain management, the demand is also growing for this data to be used for legal purposes, including the development of a potential ‘lie detector’ test for chronic pain.
“Use of such tools would be inappropriate and unethical,” said Dr. Davis.
“This technology is not foolproof. There are vast issues of variability between people and even within a person at different times.
As a result, brain imaging must not be used as a lie detector for chronic pain.”
The task force’s recommendations include the suggestion that any brain-based biomarkers should be used only as an adjunct to rather than a replacement for subjective reports of pain, even if testing is improved and valid protocols developed
Who’s going to believe a patient who says they have pain over a brain scan that says they don’t?
Ethically, this is an easy question to answer, but clinically? Legally?
People outside of the field of imaging might be disappointed, but the fact of the matter is the technology cannot be used to support or dispute a claim of chronic pain.
About the Krembil Research Institute The Krembil Research Institute (or “Krembil”) is one of the principal research institutes of the University Health Network. The Krembil is focussed on research programs dedicated to brain & spine, arthritis and vision disorders with a goal to alleviate debilitating chronic disease through basic, translational and clinical research.
Science becomes dangerous in the hands of lawyers:
Chronic pain is the greatest source of disability globally and claims related to chronic pain feature in many insurance and medico-legal cases.
Brain imaging (for example, functional MRI, PET, EEG and magnetoencephalography) is widely considered to have potential for diagnosis, prognostication, and prediction of treatment outcome in patients with chronic pain.
In this Consensus Statement, a presidential task force of the International Association for the Study of Pain examines the capabilities of brain imaging in the diagnosis of chronic pain, and the ethical and legal implications of its use in this way.
The task force emphasizes that the use of brain imaging in this context is in a discovery phase, but has the potential to
- increase our understanding of the neural underpinnings of chronic pain,
- inform the development of therapeutic agents, and
- predict treatment outcomes for use in personalized pain management.
The task force proposes standards of evidence that must be satisfied before any brain imaging measure can be considered suitable for clinical or legal purposes.
The admissibility of such evidence in legal cases also strongly depends on laws that vary between jurisdictions.
For these reasons, the task force concludes that the use of brain imaging findings to support or dispute a claim of chronic pain – effectively as a pain lie detector – is not warranted, but that imaging should be used to further our understanding of the mechanisms underlying pain.