How to measure a patient’s pain has always posed a problem for doctors, because pain is so subjective. No one really knows how much pain a patient is in – except the patient.
For years physicians have relied on such low-tech diagnostic measures as the Wong Baker Pain Scale – having patients choose from a list of smiling and frowning faces to represent how they feel.
“Right now, there’s no clinically acceptable way to measure pain and other emotions other than to ask a person how they feel,” said Tor Wager, an associate professor of psychology and neuroscience at the University of Colorado Boulder.
But two new high-tech methods could revolutionize the way pain is diagnosed and managed, including one that uses a modern-day crystal ball to measure pain.
A former army medic has invented a glowing orb that could someday assess pain in premature infants – giving a voice to patients too young to speak for themselves.
“Technology is advancing to the point that we’re saving infants at much younger gestational ages,” says Martin Schiavenato, PhD, RN, an assistant professor at the University of Miami School of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.
“But in order to do that, we’re exposing them to a tremendous number of invasive procedures. We know that this changes developing infants in profound ways.”
For many premature infants, the first few weeks of life includes pain that is often untreated and unrecognized. Preemies in neonatal care are pricked, prodded and probed by caregivers in a hospital environment that can overwhelm their sensory abilities. A premature infant could undergo dozens of painful procedures while in neonatal care.
“The premature infant is developing rapidly during those first few weeks of life after birth. Their brains are still being constructed, and any and all offenses that they suffer to their nervous systems have the potential to have negative effects, and sometimes tremendous negative effects, such as lifelong disabilities like hyper- or hypo-sensitivity to pain, and possibly contributions to cerebral palsy, mental retardation, and other profound lifelong disabilities,” Schiavenato said in an article on the Robert Wood Johnson Foundation website.
To better understand and treat their pain, Schiavenato invented a “crystal ball” that translates body gestures and other behavioral changes into a real time visual display of an infant’s pain. The ball – which is made of glass, not crystal — changes color depending on the infant’s pain levels.
Schiavenato likens his invention to the “tricorder” used by Dr. McCoy in Star Trek to diagnose patients.
“You pass it over patients and it lights up and tells you what’s wrong with them,” he says.
Schiavenato’s glass orb receives data from a sensor placed over a patient’s heart that measures changes in their heart rate. Another sensor in the patient’s hand records finger movements and a third sensor monitors their facial expressions. A computer then calculates the patient’s response to stress and displays the findings by changing the color of the glass orb.
Schiavenato has demonstrated the effectiveness of the orb on adult students in a laboratory setting and is now researching ways to perfect its use on premature infants. He and his colleagues have studied infant responses to eating, sleeping, diaper changes, and injections. They are now analyzing the data so that the computer can be programmed to accurately interpret how an infant is reacting to stimuli.
Schiavenato and the University of Rochester have filed for a patent for the orb and are looking for investors to help bring the machine to market. That could be a long way off – but someday that “crystal ball” could help premature infants, young children and even some adults articulate their pain and discomfort.
MRI Scan Can Diagnose Pain Levels
The technology may already exist for doctors to accurately measure how much pain a patient is in.
For the first time, scientists have used specialized MRI scans to predict how much pain people are in by looking at images of their brains. Researchers at the University of Colorado Boulder exposed volunteers to a painful dose of heat and found that it left a distinct “signature” in the brain that could be seen with a functional MRI scan (fMRI).
Researchers combed through images of 114 brains that were taken when the subjects were exposed to varying degrees of heat, ranging from warm to painfully hot. The scan was able to predict a person’s subjective pain ratings with more than 90 percent accuracy. It was also able to detect if an analgesic was used to dull the pain.
“We found a pattern across multiple systems in the brain that is diagnostic of how much pain people feel in response to painful heat,” said CU-Boulder’s Tor Wager, lead author of a study published in the New England Journal of Medicine.
Wager says the findings could lead to the development of new methods using brain scans to objectively measure anxiety, depression, anger or other emotional states.
“I think there are many ways to extend this study, and we’re looking to test the patterns that we’ve developed for predicting pain across different conditions,” Wager said.
“We’re also looking towards using these same techniques to develop measures for chronic pain. The pattern we have found is not a measure of chronic pain, but we think it may be an ‘ingredient’ of chronic pain under some circumstances. Understanding the different contributions of different systems to chronic pain and other forms of suffering is an important step towards understanding and alleviating human suffering.”
Wager and his research team were surprised to find that the neurologic signature was specific to physical pain. Past studies have shown that social pain can look very similar to physical pain in terms of the brain activity. But when researchers tested to see if the signature for heat pain would also pop up in the brain scans of people who had been through a relationship breakup, they found that the signature was absent.
The study was funded by the National Institute on Drug Abuse, the National Institute of Mental Health and the National Science Foundation.