Transforming pain medicine: Adapting to science and society

Borsook, David; Kalso, Eija

doi:10.1002/j.1532-2149.2013.00297.x

Cited by 30 publications

(23 citation statements)

References 182 publications

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“…The experience of pain and the associated brain responses are also shaped by psychological factors, including learning and memory, personality traits and states, and cognitive, emotional, motivational, contextual and cultural variables [21][22][23] . Attentional focus and an expectation of pain or pain relief (for example, from a placebo) can also alter the experience of pain and the evoked brain activity 21,[23][24][25][26][27][28][29][30] .…”

Section: Variability Of Painmentioning

confidence: 99%

“…Attentional focus and an expectation of pain or pain relief (for example, from a placebo) can also alter the experience of pain and the evoked brain activity 21,[23][24][25][26][27][28][29][30] . Chronic pain can modify brain pathways involved in endogenous pain control 21,22,25,31 , making self-regulation of pain challenging. This form of brain plasticity varies between individuals with chronic pain, adds to the variability in pain processing, and might compromise treatment outcome.…”

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Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations

et al. 2017

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624 | OCTOBER 2017 | VOLUME 13 www.nature.com/nrneurol CONSENSUS STATEMENT © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d . NeuroethicsA field that studies the implications of neuroscience for human self-understanding, ethics, and policy. Arterial spin labellingAn MRI-based brain imaging technique that detects cerebral blood flow based on magnetic tagging of blood.Nevertheless, diverse groups -including patients, researchers, clinicians, pharmaceutical and medical device companies, insurers and the legal communityseek methods for evaluating chronic pain besides selfreporting. Patients seek objective testing to demonstrate the reality of an invisible condition that is sometimes subject to doubt, researchers seek brain imaging markers that provide scientific, diagnostic and prognostic information that cannot be provided by patient self-reporting, and legal representatives and officials seek techniques to supplement self-reporting and objectively support or challenge claims related to chronic pain. Brain imaging technologies, including functional MRI (fMRI), PET, EEG and magnetoencephalography (MEG), have the potential to provide objective measurements of patterns of brain activity that underlie perceptual experiences (BOX 1). Consequently, some people are looking to brain imaging to provide a window into the experience of chronic pain, particularly because testimony based on fMRI was deemed to be admissible as evidence of pain in a 2015 state trial court in the USA 10,11 . This case was highly publicized, although the judgement was not published so no legal precedent was set, and the grounds on which the fMRI evidence was admitted were criticized by established experts in brain imaging studies of pain 10,11 . In this context, the development of a brain imaging test for chronic pain [12][13][14] has real-world consequences, so appropriate criteria for the use of such a test must be defined. Importantly, the way in which brain imaging evidence might be implemented in legal cases strongly depends on laws that vary greatly between countries. Therefore, examination of the capability of so-called 'pain-o-meter' brain imaging tests is critical, as is consideration of the use of such technology in light of societal views, neuroethics and legal issues. Thus, the aims of this Consensus Statement are to recommend criteria for the evaluation of neuroimaging measures of chronic pain, and to discuss the technical, biological, neuroethical and legal challenges related to establishing brain-based tests for chronic pain. MethodsA presidential task force of the International Association for the Study of Pain (IASP) was established in 2015 to examine the feasibility of a brain-imaging-based diagnostic test for chronic pain. The task force had three purposes: to consider the capacity of brain imaging (in particular fMRI), on the basis of its technical and physiological constraints, to detect whether an individual has chronic pain; to place th...

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Section: Variability Of Painmentioning

confidence: 99%

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confidence: 99%

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations

et al. 2017

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“…Unfortunately this cycle can be perpetuated when clinicians do not provide parents with a rational and honest explanation of treatment outcomes. The reason for this is largely because there are few effective treatments and many treatments have not received close scrutiny (i.e., Randomized Clinical Trials; see (Borsook and Kalso, 2013) and (Gilligan and Borsook, 2015). How the experience of perceived failure and guilt exerts an impact on parent brain systems remains elusive, but may undoubtedly be profound.…”

Section: The Maladaptive Feedback Loop Leading To Altered Brain Stmentioning

confidence: 99%

Circles of engagement: Childhood pain and parent brain

Simons

Goubert

Vervoort

et al. 2016

Neuroscience & Biobehavioral Reviews

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Social interaction can have a profound effect on individual behavior, perhaps most salient in interactions between sick suffering children and their parents. Chronic pain is a difficult condition that can produce considerable changes in behaviors in children that can secondarily have profound effects on their parents. It may create a functionally disabling negative feedback loop. Research supports the notion of alterations in the brain of individuals who observe and empathize with loved ones in acute pain. However, neural activity in relation to empathic responses in the context of chronic pain has not been examined. Ongoing suffering with chronic pain in a child can result in child's brain circuit alterations. However, prolonged suffering jointly experienced by the parent may putatively also produce maladaptive changes in their neural networks and consequently in parental behaviors. Here we put forth the conceptual framework for ‘Chronic pain contagion’ (CPC). We review the underlying processes in CPC and we discuss implications for devising and implementing treatments for children in chronic pain and their parents.

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“…Another significant issue in vulvodynia-treatment research concerns the consideration of what constitutes an “effective” treatment. Like the broader field of chronic pain, 82 a recent review demonstrated that many interventions for vulvodynia do not demonstrate strong efficacy in reducing the pain. 58 Moreover, many treatments for vulvodynia reduce but do not eliminate women’s vulvovaginal pain and associated sexual impairments.…”

Section: Clinical Challenges and Solutions In Conducting Vulvodynia Rmentioning

confidence: 99%

Vulvodynia: a consideration of clinical and methodological research challenges and recommended solutions

Corsini‐Munt¹,

Rancourt²,

Dubé³

et al. 2017

JPR

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Vulvodynia, an idiopathic chronic vulvar pain, is a prevalent genital pain condition that results in significant impairment to sexual, relational, and psychological functioning of affected women and their romantic partners. Despite its high prevalence, there remain gaps in knowledge and health care access for women coping with vulvodynia, given its varied clinical presentation and no widely accepted treatment protocol. The past several decades have seen important advancements in understanding vulvodynia and developing effective treatments; however, progress has been impeded due to clinical and methodological challenges in conducting research with this vulnerable population. This review presents a brief overview of vulvodynia correlates, consequences, etiology, and treatment, and then turns its attention to considering the clinical and methodological challenges that hinder vulvodynia research. Identifying these barriers alongside potential mitigating solutions is essential to developing empirically supported treatments for all women affected by vulvodynia, across all age and minority groups. Potential solutions will require researchers to broaden eligibility criteria, examine subgroups of women, and expand definitions of treatment outcomes, and may be best facilitated by more active collaboration among research groups and across relevant disciplines. Engagement in these solutions may contribute to more representative findings and the development and dissemination of empirically based treatment options for this complex pain condition.

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Transforming pain medicine: Adapting to science and society

Cited by 30 publications

References 182 publications

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations

Circles of engagement: Childhood pain and parent brain

Vulvodynia: a consideration of clinical and methodological research challenges and recommended solutions

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