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Is Chronic Pain a Disease? Evaluating Pain and Nociception Through Self-Report and Neuroimaging

  • Karen D. Davis
    Affiliations
    Division of Brain, Imaging and Behaviour – Systems Neuroscience, Toronto Western Research Institute, University Health Network, Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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      We intuitively understand what is meant by the term “disease.” Surprisingly though, there is no agreement as to the precise definition of a “disease.”
      • Scully J.L.
      What is a disease?.
      Definitions and classifications are important clinically and scientifically and should be based on science and medical facts. However, there are societal, political, and economic implications to classifying a condition as a disease, and this can impact the resources and effort to understand, treat, and cure. The article in this issue by Sullivan et al
      • Sullivan M.D.
      • Cahan A.
      • Derbyshire S.
      • Loeser J.D.
      What does it mean to call chronic pain a brain disease?.
      asks whether chronic pain should be considered a “disease” and whether neuroimaging can provide evidence for such a designation.
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      References

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        On the normal and the pathological.
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        Central mechanisms of pain revealed through functional and structural MRI.
        J Neuroimmune Pharmacol. July 24, 2012; ([Epub ahead of print] DOI)
        • Davis K.D.
        Neuroimaging of pain: What does it tell us?.
        Curr Opin Support Palliat Care. 2011; 5: 116-121
      1. International Association for the Study of Pain Taxonomy updated from H. Merskey and N. Bogduk (eds): Classification of Chronic Pain, 2nd Edition, IASP Task Force on Taxonomy, 1994. http://www.iasp-pain.org/Content/NavigationMenu/GeneralResourceLinks/PainDefinitions/default.htm

      2. Merriam-Webster Online Dictionary. Based on the print version of Merriam-Webster's Collegiate® Dictionary, Eleventh Edition. http://www.merriam-webster.com/medical/disease

        • Mogil J.S.
        • Davis K.D.
        • Derbyshire S.W.
        The necessity of animal models in pain research.
        Pain. 2010; 151: 12-17
        • Robinson M.E.
        • Staud R.
        • Price D.D.
        Pain measurement and brain activity: Will neuroimages replace pain ratings?.
        J Pain. 2013; 14: 323-327
        • Scully J.L.
        What is a disease?.
        EMBO Rep. 2004; 5: 650-653
        • Sullivan M.D.
        • Cahan A.
        • Derbyshire S.
        • Loeser J.D.
        What does it mean to call chronic pain a brain disease?.
        J Pain. 2013; 14: 317-322

      Linked Article

      • What Does It Mean to Call Chronic Pain a Brain Disease?
        The Journal of PainVol. 14Issue 4
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          Multiple 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
        • Preview
          Arguments 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 Commentaries
        The Journal of PainVol. 14Issue 4
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          We appreciate the thoughtful comments of Drs. Mackey and Davis.1,2 However, we would like to draw the reader’s attention to a few aspects of their responses that may help to clarify differences between us.
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