Brain Imaging to Diagnose Chronic Pain? Not so Fast.

Sep 11, 2017

Legal claims related to chronic pain prompted an IASP presidential task force to examine the capabilities of brain imaging to diagnose chronic pain and the ethical and legal implications of its use for this purpose. Having completed its assessment, the task force has published a consensus statement in Nature Reviews Neurology that advises against its use to determine whether a person has chronic pain.

Brain imaging tests for chronic pain: medical, legal, and ethical issues and recommendations” emphasizes that although the use of brain imaging in this context is still in a discovery phase, it 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.

Yet according to task force chair Karen D. Davis, “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.” She noted that brain scans cannot and should not be used as “lie detectors” to determine whether a person is in pain.

The statement proposes standards of evidence that must be satisfied before any brain imaging measure can be considered suitable for clinical or legal purposes and concludes that the use of brain imaging findings to support or dispute a claim of chronic pain is unwarranted at this time.

The task force, established in 2015 to examine the feasibility of a brain-imaging-based diagnostic test for chronic pain, had three purposes: (1) 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; (2) to place the capability of brain imaging as a diagnostic test for chronic pain in an ethical and legal context; and (3) to establish guidelines for health-care systems, governments, and policy makers on the validity and ethics of adopting a brain-imaging-based test for pain.

Members of the task force were chosen by Davis and then-IASP President Rolf-Detlef Treede to provide expert opinions across the fields of brain imaging technologies, basic and clinical science of pain, psychology, neuroethics, and the law. In addition to Davis and Treede, its members included Herta Flor, Henry T. Greely, Gian Domenico Iannetti, Sean Mackey, Markus Ploner, Amanda Pustilnik, Irene Tracey, and Tor D. Wager.