Central neuroimaging of pain has emerged as an effective way to assess central nervous
system correlates and potentially also to characterize mechanisms of human pain perception,
modulation, and plasticity. Central neuroimaging has allowed us to open windows into
the brain to observe the roles of attention,
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anticipation,
11
fear/anxiety,
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placebo,
2
direct control,
6
and other factors. We now better understand the changes in the brain associated with
chronicity of pain,
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,
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the effects of opioids,
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,
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and effects of nonopioid therapies.
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The benefits we have gained from using central neuroimaging clearly advance our scientific
knowledge of pain. However, the authors of 2 articles in this issue of the Journal of Pain suggest that perhaps our use of neuroimaging overreaches in our attempt to address
2 important questions: 1) Does brain neuroimaging replace self-reporting of pain or
will it do so in the future? and 2) Do central neuroimaging findings alone define
pain as a disease? The authors of these articles
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,
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make compelling arguments that the answers to both these questions are an emphatic
“No.” I would agree. However, it would be too easy to lose sight of neuroimaging’s
potential role in augmenting self-report of pain, detecting or classifying pain and
pain states, and helping define chronic pain as a disease. The story is much richer
and deserves further consideration.To read this article in full you will need to make a payment
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- What Does It Mean to Call Chronic Pain a Brain Disease?The Journal of PainVol. 14Issue 4
- PreviewMultiple investigators have recently asked whether neuroimaging has shown that chronic pain is a brain disease. We review the clinical implications of seeing chronic pain as a brain disease. Abnormalities noted on imaging of peripheral structures have previously misled the clinical care of patients with chronic pain. We also cannot assume that the changes associated with chronic pain on neuroimaging are causal. When considering the significance of neuroimaging results, it is important to remember that “disease” is a concept that arises out of clinical medicine, not laboratory science.
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- Pain Measurement and Brain Activity: Will Neuroimages Replace Pain Ratings?The Journal of PainVol. 14Issue 4
- PreviewArguments made for the advantages of replacing pain ratings with brain-imaging data include assumptions that pain ratings are less reliable and objective and that brain image data would greatly benefit the measurement of treatment efficacy. None of these assumptions are supported by available evidence. Self-report of pain is predictable and does not necessarily reflect unreliability or error. Because pain is defined as an experience, magnitudes of its dimensions can be estimated by well-established methods, including those used to validate brain imaging of pain.
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- Reply to CommentariesThe Journal of PainVol. 14Issue 4
- Reply to CommentaryThe Journal of PainVol. 14Issue 4
- PreviewThe commentary by Sean Mackey3 makes several interesting points, many of which show strong agreement with the points raised by all of the other articles. Within the early part of his article he agrees that brain neuroimaging will not replace self-reporting of pain nor will it do so in the future and that central neuroimaging findings alone do not define pain as a disease. He then raises concerns that, based on our arguments forcefully presented to readers,6 they “may lose sight of the real value of central neuroimaging—a way to augment self-report of pain and a potential, objective [italics ours] biomarker of pain and pain treatment.”3 There are several points we wish to make about Mackey’s concerns that we think help clarify our agreements and disagreements.
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