Scientists seek ways to finally take a real measure of pain

Scientists seek ways to finally take a real measure of pain

http://www.tribtown.com/2019/01/10/us-med-measuring-pain/

WASHINGTON — Is the pain stabbing or burning? On a scale from 1 to 10, is it a 6 or an 8?

Over and over, 17-year-old Sarah Taylor struggled to make doctors understand her sometimes debilitating levels of pain, first from joint-damaging childhood arthritis and then from fibromyalgia.

“It’s really hard when people can’t see how much pain you’re in, because they have to take your word on it and sometimes, they don’t quite believe you,” she said.

Now scientists are peeking into Sarah’s eyes to track how her pupils react when she’s hurting and when she’s not — part of a quest to develop the first objective way to measure pain.

“If we can’t measure pain, we can’t fix it,” said Dr. Julia Finkel, a pediatric anesthesiologist at Children’s National Medical Center in Washington, who invented the experimental eye-tracking device.

At just about every doctor’s visit you’ll get your temperature, heart rate and blood pressure measured. But there’s no stethoscope for pain. Patients must convey how bad it is using that 10-point scale or emoji-style charts that show faces turning from smiles to frowns.

That’s problematic for lots of reasons. Doctors and nurses have to guess at babies’ pain by their cries and squirms, for example. The aching that one person rates a 7 might be a 4 to someone who’s more used to serious pain or genetically more tolerant. Patient-to-patient variability makes it hard to test if potential new painkillers really work.

Nor do self-ratings determine what kind of pain someone has — one reason for trial-and-error treatment. Are opioids necessary? Or is the pain, like Sarah’s, better suited to nerve-targeting medicines?

“It’s very frustrating to be in pain and you have to wait like six weeks, two months, to see if the drug’s working,” said Sarah, who uses a combination of medications, acupuncture and lots of exercise to counter her pain.

The National Institutes of Health is pushing for development of what its director, Dr. Francis Collins, has called a “pain-o-meter.” Spurred by the opioid crisis, the goal isn’t just to signal how much pain someone’s in. It’s also to determine what kind it is and what drug might be the most effective.

“We’re not creating a lie detector for pain,” stressed David Thomas of NIH’s National Institute on Drug Abuse, who oversees the research. “We do not want to lose the patient voice.”

Around the country, NIH-funded scientists have begun studies of brain scans, pupil reactions and other possible markers of pain in hopes of finally “seeing” the ouch so they can better treat it. It’s early-stage research, and it’s not clear how soon any of the attempts might pan out.

“There won’t be a single signature of pain,” Thomas predicted. “My vision is that someday we’ll pull these different metrics together for something of a fingerprint of pain.”

NIH estimates 25 million people in the U.S. experience daily pain. Most days Sarah Taylor is one of them. Now living in Potomac, Maryland, she was a toddler in her native Australia when the swollen, aching joints of juvenile arthritis appeared. She’s had migraines and spinal inflammation. Then two years ago, the body-wide pain of fibromyalgia struck; a flare-up last winter hospitalized her for two weeks.

One recent morning, Sarah climbed onto an acupuncture table at Children’s National, rated that day’s pain a not-too-bad 3, and opened her eyes wide for the experimental pain test.

“There’ll be a flash of light for 10 seconds. All you have to do is try not to blink,” researcher Kevin Jackson told Sarah as he lined up the pupil-tracking device, mounted on a smartphone.

The eyes offer a window to pain centers in the brain, said Finkel, who directs pain research at Children’s Sheikh Zayed Institute for Pediatric Surgical Innovation.

How? Some pain-sensing nerves transmit “ouch” signals to the brain along pathways that also alter muscles of the pupils as they react to different stimuli. Finkel’s device tracks pupillary reactions to light or to non-painful stimulation of certain nerve fibers, aiming to link different patterns to different intensities and types of pain.

Consider the shooting hip and leg pain of sciatica: “Everyone knows someone who’s been started on oxycodone for their sciatic nerve pain. And they’ll tell you that they feel it — it still hurts — and they just don’t care,” Finkel said.

What’s going on? An opioid like oxycodone brings some relief by dulling the perception of pain but not its transmission — while a different kind of drug might block the pain by targeting the culprit nerve fiber, she said.

Certain medications also can be detected by other changes in a resting pupil, she said. Last month the Food and Drug Administration announced it would help AlgometRx, a biotech company Finkel founded, speed development of the device as a rapid drug screen.

Looking deeper than the eyes, scientists at Harvard and Massachusetts General Hospital found MRI scans revealed patterns of inflammation in the brain that identified either fibromyalgia or chronic back pain.

Other researchers have found changes in brain activity — where different areas “light up” on scans — that signal certain types of pain. Still others are using electrodes on the scalp to measure pain through brain waves.

Ultimately, NIH wants to uncover biological markers that explain why some people recover from acute pain while others develop hard-to-treat chronic pain.

“Your brain changes with pain,” Thomas explained. “A zero-to-10 scale or a happy-face scale doesn’t capture anywhere near the totality of the pain experience.”

5 Responses

  1. Good in therory, but they may need to try a different approach. With Trigeminal neuralgia it affects the nerves in the eye as well, so this may not work for that type of pain reason.
    Perscribing the meds like Lyrica for sciatica or nerve damage is useless for Most patients period! Opioid meds actually Reduce the amount of pain like they are meant to do. That part of the article is Wrong. That is only an assumption from a Dr that Never experienced or has any clue about how it actually feels!

  2. OK, I have 10 denigrated dick in my spine. 3 fusions in my back, 2 fusions in my neck. Over 20 surgeries. Look at my MRI’s and then ask me if I’m in pain. My Pain Management doctor took me off Opioid pain meds that worked for over 25 years and switched me to a lesser pain med that doesn’t work as good. So what is the pain tracker going to tell me Doctor, yes, this guy is in pain? After looking at my MRI’s shouldn’t he know that are is he thinking I’m faking it?? I got to thinking REALLY!! Will this change anything???

  3. “. “We do not want to lose the patient voice.”
    2 comments to that:
    1. patients no longer HAVE a voice that gets listened to: the Church of Opiophobia (A Kolodny, founder) has taken care of that.
    2. Shurrrrr they don’t.

  4. I didn’t see the blog talk about short term vs long term years of pain. It sounds interesting but I wonder if a person that has suffered in pain for years measures the same results as someone that has just started having pain. You would think a long time chronic pain sufferers body and nerves would adjust after years of pain. Now the brain scan would be also interesting if they can start at injury and monitor it for years and see if it has changed.

  5. Geez-Us…, WHEN are they simply going to “go back” to the WISDOM that used to be utilized when a “trained” “Human” “medical person” does their protocol: perhaps a physical exam, etc…, is OBSERVANT to patient reactions, and finally and perhaps THE most important part:: LISTEN!!! HEAR!!! MOST IMPORTANT– TRUST THAT THE PATIENT IS TELLING YOU THE TRUTH!!!!!
    What has happened to this???? This whole situation has created a horror of PTSD (speaking for myself…), & it has evolved to now “white-coat hypertension” as well…, this situation is so very backward…, it blows my mind that is is REAL…., & CREATING more & more sickness/illness/suicide/death/depression/rage, etc, as it continues…., I am a person who must also deal with the “medico-political-industrial complex’s COLLUSION OF DENIAL of ” Chronic” Borrellia/Tick-Borne infection, which the CDC has “allowed” to spread & become a SEVERE EPIDEMIC, “here” & now, GLOBALLY… (please see the DOCUMENTARY: “UNDER OUR SKIN”, & The just published book by Investigative Journalist MARY BETH PFIEFFER, called: “LYME: THE FIRST EPIDEMIC OF CLIMATE CHANGE”…
    – -WHAT ARE THE “CHANCES” THAT THESE TWO “EPIDEMICS” ARE HAPPENING AT THE SAME TIME????? SIMULTANEOUSLY????
    Guess what one of he MAIN symptoms of Lyme/TBD is??? PAIN!!!! SEVERE PAIN…, typically in bones/joints…, next, INSOMNIA…. (making it hard for your body to heal…) everytime I walk into a Dr office now… The whole continuous, RELENTLESS FOCUS on this “addiction” propaganda is extremely stressful in itself–but NOW…., THERE ARE ALL MANNER OF CODES FOR “NEW DISORDERS RELATED TO PAIN!!
    In Mary Beth book for example, A CHILD IN CONTINUOUS, RELENTLESS PAIN, brought to Dr after dr, DENIED pain meds–INSTEAD: DIAGNOSED WITH…….
    ……”PAIN-AMPLIFICATION” SYNDROME!!!!!
    (until of course the TBD-related diagnosis reveals…., dun-dun…, THIS CHILD WAS NEVER LYING!!!!) This child was in HORRIFIC PAIN!!!! (& I cannot even imagine what his parents went through trying to desperately help ease his pain….) Now, there’s, let’s see…, “SUBSTANCE-“USE” DISORDER?????” WTF is THAT????
    I get angrier and angrier the more I write & realize how many of us are going thru this, we do all we can–SIGN PETITIONS, GO TO RALLY’S, GO TO OUR LEGISLATORS…, LAWYERS have not wanted to help–with my case at least!’ What more to do????
    This has now changed the dr/patient relationship–for those with persistent PAINFUL conditions, for which they need continued medical visits & prescriptions
    “THEY…”, the “patient”, are the ONLY known “EXPERT” with the KNOWLEDGE no one else in this entire World has about their own body!!!! (except that which created them)…
    They’ve lived in this body from the day they were born…. There IS no “expert” who resides outside of YOUR body… I don’t care how many “tests” they “think” they can create to “measure” “real” pain–both the “test”, & the medical person exist OUTSIDE a patient’s body! & until they can become like the character “JOHN COFFEE” in the movie, “The Green Mile…”, it remains an IMPOSSIBILITY to truly know with any kind of “certainty”…
    ….Unless we are actually LISTENED TO…., HEARD….., & TRUSTED in our dialogue & communications with these “doctors…”
    THIS HAS GONE TOO FAR….

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