Objective Measures of Pain or a Journey Down the Rabbit Hole

Using functional magnetic resonance imaging (fMRI) techniques, we have been able to open windows to the brain, to noninvasively study its structure and function. Pain processing within the central nervous system (CNS), brain and spinal cord, and how it is disrupted in chronic pain has been increasingly characterized using neuroimaging. However, to date, fMRI has provided minimal direct clinical application for pain. We believe that will soon change. Furthermore, the use of more sophisticated analysis techniques is providing us with greater mechanistic understanding of the role of the brain in pain. The purpose of this course is to provide an overview of recent advances in the development of brain based biomarkers for pain that hold the potential for advancing the goal of precision pain management: finding the specific treatment for the specific person with the specific painful condition. We expect that brain based biomarkers will be used to help predict those who develop chronic pain or persistent opioid use after surgery, as well as for prognosis to identify who will respond to a particular treatment. The topic of brain based biomarkers has generated much controversy over the past several years in the media, legal community, and even in our own scientific community. We have recently published a consensus statement from the International Association for the Study of Pain that will be reviewed. We hope to engender good discussion and help attendees understand that no single region within the CNS is responsible for the brain representation of acute or chronic pain. Also to be discussed is how machine learning is a new and powerful technology allowing for a whole-brain identification of altered brain structure and function in chronic pain. It may ultimately help to develop brain based biomarkers of pain and advance the goal of precision pain management. (Recorded at PAINWeek 2018)