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

• Published in: Nature reviews. Neurology Vol. 13; no. 10; pp. 624 - 638
• Main Authors: Davis, Karen D., Flor, Herta, Greely, Henry T., Iannetti, Gian Domenico, Mackey, Sean, Ploner, Markus, Pustilnik, Amanda, Tracey, Irene, Treede, Rolf-Detlef, Wager, Tor D.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2017; Nature Publishing Group
• Subjects: 692/1807/410/2610; 692/700/1421/65; 706/648/179; consensus-statement; Medical imaging; Medicine & Public Health; Neurology; Pain; Task forces
• ISSN: 1759-4758; 1759-4766
• DOI: 10.1038/nrneurol.2017.122

Key Points With suitable standardization and validation, brain imaging could provide objective biomarkers of key characteristics and mechanisms related to chronic pain, that could guide personalized pain management Brain imaging shows promise in the assessment of risk factors for chronic pain and in identification of the mechanisms that underlie transition to, and maintenance of, chronic pain Identification of brain-based markers of chronic pain requires technological advances, large-scale data acquisition across diverse groups of individuals, and strict application of standards of evidence Brain-based biomarkers should be used as an adjunct to rather than a replacement for subjective reports of the pain experience Use of brain imaging as legal evidence of an individual's pain is not advisable until the specificity and sensitivity of such tests are improved, and validated protocols exist Current brain-based measures should be used only to understand brain mechanisms underlying pain, factors that lead to persistence of pain, and targets in the brain for safe and effective pain management Chronic pain is the greatest source of disability globally and claims related to chronic pain feature in many insurance and medico-legal cases. 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 such uses of brain imaging. 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.