New Test Objectively Measures Pain

New Test Objectively Measures Pain

By Staff.

If you’re one of the 100 million U.S. adults who suffer from chronic pain, you’re familiar with the Visual Analog Scale (VAS) used to indicate pain levels.  Despite its widespread use, researchers want a more objective measurement because it would better serve both chronic pain sufferers and healthcare providers.

“Sadly, this scale of smiley faces, called the visual analogue scale, is the gold-standard pain-assessment tool,” said Carl Saab, an associate professor of neuroscience and neurosurgery at Brown University and Rhode Island Hospital. “Our goal is to associate specific brain activity with various scores on the numerical scale to make pain assessment more objective. We want to help patients with chronic pain and their physicians get into agreement about pain level so it is better managed and diagnosed, which may reduce the over-prescription of opioids.”

Saab and his colleagues developed an electroencephalography-based test to objectively measure pain. Electroencephalography (EEG) is a method that measures brain activity using electrodes placed on the scalp. The brain activity is measured in the form of oscillations or “waves” of a certain frequency, somewhat like the specific frequency that dictates a radio station.

A frequency that correlates with pain in animals is called the “theta band,” Saab said. Computational analysis of theta brain waves to determine their power can be used to objectively measure pain in rodents and humans in a non-invasive manner, he added.

In a Nov. 6 paper published in Scientific Reports, Saab’s team reported that measuring the power of theta waves using EEG is an effective and direct test of pain and potential pain medication efficacy in pre-clinical animal models.

Testing new pain medications

The current method to measure pain, and the effectiveness of potential pain medications, in a pre-clinical animal model is to poke the animal’s paw and see how quickly it moves its paw away. Slow paw withdrawal is linked to less pain and better pain medication. Faster paw withdrawal is linked to more pain and less effective pain medication.

“When I was a graduate student, I hated this test because it had nothing to do with clinical pain,” said Saab. “Nobody pokes a patient with back pain. I’m just so happy that I beat this test, now we’re working with something better.”

Since the EEG-based test is a more direct measure of ongoing, spontaneous pain than the current approach, it could help researchers develop more effective medications for chronic back pain or sciatica, which don’t have many effective treatments, Saab said.

In the paper, his team looked at three pain medications and compared their effectiveness in an animal model of sciatica. The researchers used the traditional behavior test, the EEG test and an analysis to determine blood concentration of the medications, which was compared with the clinical blood concentration of the medications in human patients.

The first medication they tested was a proven treatment for some forms of chronic pain, which is sold under the brand name Lyrica. The second was a promising pain medication in phase two clinical trials, and the third was a medication with inconclusive effectiveness in earlier studies.

Overall, the theta wave measurement and behavior test gave similar results, said Saab.

However, for a few of the experiments, such as a dose below the effective level of the first medication, the EEG test provided results that were more accurate — more similar to the results found in patients than the behavior test — said Saab. Specifically, the EEG test showed a decrease in theta power measurement at the clinical dose but not the low dose, while the behavior test showed slower paw withdrawal at the low dose and the clinical dose. By indicating pain relief at a dose lower than the effective dose, the behavior test gave a false positive.

“The ability to detect false positive or false negative outcomes is crucial to the drug development process,” the authors wrote. Saab believes that the EEG test can aid researchers in identifying false positives in pre-clinical trials of new pain medications, improving the development process.

Future impact of pain test

The ultimate goal of the research is an objective tool to measure pain for clinics and emergency departments. Toward this end, Saab is working to translate his findings to patients by calibrating the EGG signatures of pain with the traditional smiley-face-based pain assessment tool.

In addition to aiding the development of more effective pain medications and improving the diagnosis and management of chronic pain, both of which address contributing factors to the opioid epidemic, an objective measure of pain could improve health disparities, Saab said. These range from women whose pain is dismissed by medical practitioners to patients with difficulty communicating, including young children.

Three years ago, Saab launched a start-up company to develop the next generation of pain sensors, which he hopes can become the new gold standard for pain measurement. Saab added there’s considerable interest in a pain measurement tool for veterinary medicine.

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Authored by: Staff

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Angie H

I read this article twice and read thru the comments too. A few things I don’t like, one testing animals I understand is sometimes needed but not when cruelty is involved. Poking an animal that is in pain is a very good way to get bit and truthfully you would deserve it. I personally underwent a multitude of tests and every time they had to touch my CRPS/RSD arm and hand I wanted to scream and hit them. Two everyone experiences pain differently. Some people have a naturally high pain tolerance and others have a very low pain tolerance. I saw several comments about high pain levels causing a high blood pressure. Yes that is very common but again not true for everyone. My pain levels go up and my blood pressure goes down. It took us awhile to figure this out, and is actually more dangerous than a high blood pressure.
Another common problem is not everyone responds to meds the same way and most people that live with chronic pain disorders have a very large list of allergic reactions to medications.
I am at the bottom of the barrel (so to speak) there is nothing else they can try. If they remove my meds I am screwed as I am allergic to everything else.
This doctor needs to rethink his agenda because people are different and not every one will have the same response to the EEG pain scale test, yet actually be in extreme pain.
Try paying attention to the patient and their medical conditions and history. Guess what that doesn’t lie and alot harder to fake.

Louis Ogden

There is no objectivity here. It’s an ad for a gadget that supposedly measures pain and, at the same time, an ad for Lyrica

Leticia

It is so important to pain patients to watch the words we say..Patients with painful diseases,illnesses, injury and their legal pain medication has nothing to do with illegal heroin/ fentenyal crisis and never has! Anything that has to do with illegal drug overdoses should not be put along with pain patients treatment. This is why so many thousands of pain patients are suffering because policy maker and others and even some medical community are still going after pain medication. The ama just released resolution’s saying that the cdc guidelines have been misapplied. And legal prescribing is not and has never been driving the illegal heroin/ fentenyal crisis!

Alan Edwards

When one sees “lyrica reduces chronic pain”; “reduces the over-prescribing of opioids”;” hopes to sell a new sensor”. Then the article is biased and promotes false information.

Lyrica is being pushed by the fda and thus doctors, despite it’s abuse in Scotland, to treat intractable pain. It works only against neuropathic pain and is expensive and worthless against intractable pain. I took it.

They don’t trust the best source of pain measurements. The patient.

Shame on National Pain Report for giving Saab a platform for his objective pain measurement, there is no objectivity involved in it. Saab is just trying to say it is all in our head. This report is one of the most insane things I have read. I would like to see how fast Saab would move his “paw” away if he were poked. Torture of animals should not be allowed in the first place. My pain doctor gave my oxycodone back last month but I am forced to take it with acetominaphen in the form of percocet.He said he wanted to turn over a new leaf in my case. I would like to believe him 100% but I am afraid he will take my oxy from me again. He has cut me and taken it from me before, the last time for seven months.During that time my body crossed a line it will never recover from. The nurse told me my blood pressure was up again before I saw him. I told her it is a problem that easily happens now. The doc assured me he would not take my oxy again but I told him I was just waiting for the next shoe to drop. He said it is not going to drop. I had my bilateral nerve blocks done that day also in the abdomen which I had also not been given for seven months. They asked if my surgeon had ever discussed taking out the nerve and I said no. I have to have a hernia surgery again on Dec. 12th. because I get attacks from it too. I am going to ask my surgeon if he can remove the nerve sometime because I am so afraid of the pain I might be forced to endure if my meds are cut again. What people like Saab do not understand or just do not care about is that we are already subjects in his lab. It makes me sick to see articles like his printed on a forum that is supposed to care about us. But thank you National Pain Report for allowing us to voice our opinions and cries for help. I hope Saab reads this forum. He should be directed to do so.

Jill

Are they serious? Just ask!!

Susan

This is ridiculous. I can tell my husband of 30 years is in horrible pain by looking at his eyes or listening to him breathe (or hold his breath, in the case of bad pain). His blood pressure has been as high as 180/130 due to pain. His neck looks like tightly wound piano wire where it isn’t swollen. He gets THREE hydrocodone 10/325 per day, which averages about 2 hours of pain relief per day. That’s it, and he’s “lucky” to get that.

I hate doctors. We have been to countless specialists over the past decade, and most of them have done far more harm than good.

My heart breaks for all of us.

Jesse

I have type 2 diabetes neuropathy disc disease of the spine iam in chronic pain all day every day my dr gives me lyrica and it doesn’t help at all i told him that and i do understand that theres not much they can do about it but theres gotta be something to help control it

JAnice

Great another bull dung road to another lost cause experiment. While time is being futilely wasted on fares experiments , my sons father for being in pain commuted suicide before thanksgiving. He was in so much pain and was so fed up with the run around from the medical community , he took matters into his own hands.
We will never see him again . He won’t be there to watch the rest of my sons life… I’ve lost my best friend I’ve known since I was 12 years old. HOW MANY MORE TIMES DO WE HAVE TO HAVE THIS DISCUSSION? How many more people have to outright suffer at the hands of our medical community’s posturing and acceptance of the DEAs ruining and horrid intrusive intrusion into the lives of those suffering. If our medical Drs and practitioners can’t do any better for those who seek their attention in times of need than be slanted and abide by fools to treat the patients they are lisenced. Way more harm than good has now been done by this messed up phonetic baloney opioid crisis [edit]. That’s putting it lightly .

Every dr that views their patient as drug seeking or classifies their patient in any manor other than compassion and empathy for their pain or physical and mental trauma they are enduring, needs to fully comprehend the damage and the cascading effects that attitude has on a human life. May every dr feel the dispair my sons father felt in his last moments being in such unbelievable pain.

May every [edit] that thinks they are saving addicts feel the torture my sons father felt at his desperate point place and time when my sons father took his life.

No one NOONE should be humiliated and suffer the abuse of power and denied the pursuit of a decent happy productive life .
I urge those of you who are suffering to hang in there. It’s not your fault those ” In charge” in the medical community are suffering from stupidity that is beyond reproach. That our insurance industry and the DEA can’t operate with empathy compassion or kindness .

Christine

Sorry! I just had to add one more comment! After reading other input I wanted everyone to notice the last paragraph in the above article which I did not pay attention to initially!
Dr.Saab’s goal is not to help anyone of us…………
Dr.Saab is working to help himself to promote and sell his “PAIN Sensor” product he developed 3 years ago. I knew when I first read this I didn’t understand. the point of the article?
The point is he’s attempting to convince his Dr. colleagues that they and hospitals and emergency clinics- ” Doc – in – the – Box” operations they need to buy his pain sensor……….
So every patient who comes in acute pain can be judged to be telling the truth or not the truth.
“Lightbulb” went on in my head!
I am an RN. I have lot’s of relevant experience in ER , OR, Recovery Room, and Obstetrics which can be like working a “Mash” unit depending on the Obstetric Emergency.
My first thought was Dr. Saab was suggesting we should all be hooked up to an EEG machine.
What he’s intending is for him to do the research and correlate his findings to improve his gadget for his “PAIN Sensor” device he wants to sell to only certain segments of the population. What I have named above and Veterinary Medicine Groups.
You know more Dr.s to sell to!
And yes, being on Pain meds, and Muscle Relaxers no wonder I had to re- read the article a few times to get it.
No offense “National Pain Report” but you published this and now it’s being touted on “Google” as the next “New” thing for the Pain Community!
See even you bought in to this guy’s intention “to get the word out about his device”.
But you have to “Read Between the Lines” to do it!
We’ve all been had!!!!!!!!!!

April Dawn

I am sorry but I have been betrayed over and over again by 99.99% of ANYONE (person or system) that is involved with pain management field. To me this screams just another way to deny the REALITY of the severe disability pain I live in – it is torture and hell. I can clearly articulate exactly how much pain I am in. I can give lists of all the specific treatments I have tried (including medications PT, therapy, “relaxation” techniques, food, herbals, targeted pharmaceutical grade supplements, “non-traditional” methods such as acupuncture, and on and on. Over 15 YEARS of it. I was on pain medications at a level that brought back enough quality of life to make it worth living – it worked – nothing negative happened – I did nothing wrong. And all of a sudden my pain medications are being tapered down, I am in agony again – – for NO medical reasons – it has nothing to do with me or my quality of life. Again. AND, I am now being treated far worse than a criminal. So excuse me if I don’t trust any of this, not at all. The only point for this would be for someone who is unable to communicate their pain levels – otherwise it is clearly stating – patient are lying about their pain and we are going to prove it. AS far as finding new medications for pain – forget it – the dirty secret is out – Medications that were practically forced down my throat (I was basically forced to take them – if I didn’t – they wouldn’t prescribe opioid pain medications that actually work), things like Lyrica and cymbalta – they have HORRIBLE side-effects, and, when you finally are ready to quit them, you find out that they give you multiple forms of agony from WITHDRAWAL! I was lied to so many times about that – only opioids and benzos cause withdrawal right? AND these new drugs (for which no one really has a clue what they do to different people’s bodies – in different combinations and for different amounts of years), didn’t help me at all – didn’t lower pain.

Kim

What is the point? If it does show someone is in horrific pain, is the government going 2 allow pain specialists 2 issue higher aim meds? I doubt it. I never understood the smiley pain chart. My level 10 pain is equal 2 labor pain & I need 2 b crying 2 say level 10 & other people who r walking around smiling say their pain is level 10. If MDs truly get 2 know their patients they would not need a scale, they will know by looking & talking 2 their patient.

Lenore Arbaugh

Absolutely do not believe this test will be valid. The results can be skewed or misinterpreted. It sounds like another attempt to withhold pain medications from suffering people.

Christine

I agree with Adam! My first thought was “Why are you torturing animals”
I’m an RN an have witnessed people in pain!
From a ” grimace” to ” writhing” in pain!
In practice” in the real world” are you saying that the medical community needs to have everyone hooked up to an EEG, for a “brainwave” study before being medicated for pain?
Pardon my English- ” but that ain’t going to happen!”.
Take for example ” Women in Labor” you mean to tell me as an RN I have to get an EEG
” brainwave” study ordered by an obstetrician or an anesthesiologist before I take action to get an appropriate pain medication or an epidural procedure performed?
Now that’s a large ” group ” of women since that’s the sex the researcher referenced ” Women”.
I am a woman who also had prior to my Trigeminal Neuralgia Type 1 and Type 2; suffered from Endometriosis the ” woman’s disease”.
And guess what? Most male Dr.s were not convinced about ” my Pain level” and I’m sure that’s because men don’t have to go through a ” once a month” painful event like ” menstruation” which if you have ” Endometriosis” hurts like bloody h _ l l !
And as a working woman for ten years I’ve already got kidney damage from my intake of Advil use for 10 years.
So thank you so much for the Opiod Crisis, who now thinks they should return me to damaging my kidneys more with Ibuprophen and Tylynol.
Which I know already is not going to “touch” my Pain level at all!
Gee! Do I sound angry? You bet!
Takes me right back to my memories of everything I went through straight up to the surgical intervention of my ” Woman’s Disease”. As well as my trials and tribulations I have gone through now since my current diagnosis was bestowed on me.
The remedies of all the medications, treatments, procedures, Gamma knife radiation, and surgeries I have endured willingly just to relieve the “PAIN”.
Now another ” Research” guy wants to hook me up to an EEG, just to prove to him that I’m in pain or at the appropriate level of pain to “Prove” to him?

Edward Hirsch

It’s awsome that there are people out there working to bring relief to those suffering from cronic pain. I have watched as drs and health care providers are attacked for providing patients with opiate based medications. There are millions of people who need theses products to live a normal life. The people who abuse these medications are hurting the people who truely suffer from cronic pain. I pray for all of us that all the people who work so hard to find alternative pain relief are successful. I have lost two people i love who took their own lives because they couldn’t get the help they so desperately needed. Thank you all.

Sharon C.

An objective test to determine pain levels in chronic pain patients could help doctors decide on the strength of the opiate to prescribe. Based on such a test, doctors could stop prescribing opiates completely. Maybe test results show that
patients with low levels of pain could benefit from meditation instead of all those
nasty opioids? Some doctors might feel vindicated by these test results, knowing
the pain was all in her head, after all. But consider that some chronic pain patients have varying levels of pain, depending on the day. My CRPS lets me
know my level of pain, not just daily, but hourly sometimes. I could take this
objective test at a time when there is less pain. Test over, no more opiates,
left to suffer unspeakable pain the next hour, or next day. That would be the
end for me.

Jeanne

We definitely need more research and this study is definitely lacking. After 25 years in the medical community I no longer trust research even if it says it is at its highest levels. Therefore these studies will have to go through much more rigorous testing for authenticity than the usual. I would want to be a test subject. Why didn’t they mention the other 2 names of the medications. Why aren’t they testing current medications. None of this should go into practice without explicit consent of the patient and all healthcare members in the patients team! Thank-you.

Cindy

I don’t understand how any measure of pain can be totally objective. Different people feel things differently. I”ve always been hyper sensitive to lots of things, and earned the nickname of “princess and the pea”. Unfortunately, it’s true, and it’s a very hard way to live. I’ve never recovered from injuries like “normal” people do, and I feel everything, a lot. I dont’ want a machine telling my doctor that I shouldn’t be feeling what, unfortunately, I do feel.

Terry

Well I’m glad they are making progress in diagnosing pain, unfortunately it’s so they can lower people’s pain meds, not to raise them to the levels that they need to be at. I can’t see how progress in this area is going to help the chronic pain patient, since most pain patients are now taking way less than they need, to adequately deal with their pain. The bottom line is that the DEA is still going to dictate how much pain medication we are allowed to take. So as usual we are just left out in the cold to deal with our chronic pain the best way that we can. Yet another useless test! I like the smiley face test better, even though the outcome is still the same. Everyone keep writing your congressmen and senators, at least it will feel like we are doing something. God bless all of my chronic pain brothers and sisters.

Why would researchers want to develop a “more effective medication” for those with chronic back pain, sciatica among other things when we already have something that does the job and does it extremely well I might add!? Develop something else to give relief and then have it ripped off the market as our opioids have been? We are not mice that are poked we are human beings with hearts that have been broken, human beings with real chronic pain problems. Problems that have been abandoned leaving all of us to feel helpless, hopeless, guilty, ashamed, embarrassed, and defeated just to mention a few. Whether it be a scale from 1 to 10 or an EGG that would show chronic pain as chronic pain, what good is it going to do if there’s nothing to treat the chronic pain with? We don’t have time to wait for developer’s or researchers to develop something new for our chronic pain. We’re talking about good people who have lost their jobs, homes, families, social lives, their livelihoods and some the will to live at all! I also find it most inappropriate that Mr. Saab added to his article that this device would also be of help to animals as well. Saab should have left that quote out completely for right now our animals get all the pain treatment they need and then some. It’s the 100 million of us chronic pain patients who are the ones who are in desperate need of help!

T J

Been through the forced taper now for the last year after being on higher med levels for 20 years to which I responsibly did well on. Now I just ache and suffer.I was all for the taper at first until reaching a level of meds that are not sufficient , they had me so convinced that my meds were not the answer to my pain until I reached the point that I wondered how the CDC can be so blind to their effectiveness and that people do well when taken responsibly.The DEA gestapos will surely disagree because they need a reason to be as an entity to survive.Pain really drags your life down to the point of some serious negative thoughts and since we have lost the right to quality of life sustaining medication I have some desperate train of, that I haven’t had prior to this.So I could go on and on but the government has stopped listening and created a sub class of infliction.

Katie Olmstead

While I think having more tools is good, it does worry me. Pain remains subjective. I could be having a pain spike but it doesn’t show on my face. Would my being acclimated to pain then not register in my brain either? I hate the smiley faces as much as the next person but we can’t dismiss the patient’s own reported experience. It will be interesting to see how this tests over time. Yes, there is the ethical question of animal testing, not going to dismiss that.

Virginia

All these tests to find the so called “gold standard” for measuring accurate pain levels is fine for those who find it hard to communicate their said pain to their attending physicians.
My opinion, and let’s face it, we all have them, and just like our anuses they all stink, eh? (Lol), is this; the gold standard should be that doctors should be the ones to determine who is in pain, how much in pain they are in, and how much pain medication they need.
Just like any relationship there needs to be an element of trust, of give and take, and of forgiveness for mistakes because we are all human.
What many have not taken into account is that we all have shuffled the blame upon another. When we point our finger toward another there are what, at least three fingers pointing back at us. And lastly, our thumb is pointing up toward God Almighty. From whence our help comes.
The “gold standard” wants to put us all under the same umbrella and we chronics know one size does not fit all, so why do they keep trying to fix us all the same? They won’t ever be able to measure our pain levels. Why won’t they just believe the black and white reports of our x-rays, test results, etc? Because they have not found a way to make enough money in giving us opioid drugs. They’ve found a way on how to do so with marijuana, haven’t they? They make tons of money on heart meds, cholesterol, blood thinning, and diabetes medications, right? And opioids have flooded the markets, but the powers that be haven’t cashed in yet. Oh, but when they come up with a way, you and I will have as many opioids as we could ever need. We’ve been primed, folks. Just saying.

Kathleen Kaiser

Why is it so hard for the people in the medical community to believe us when we say we’re in pain. I don’t know that we could trust this thing to really accurately diagnose pain. And I’m afraid that if doctors do start using it they will stop believing the patient. Sometimes when my pain is really high my blood pressure will be up and that’s a real good indicator that I’m in pain. But sometimes my blood pressure will be just fine even though I am writhing in pain. So it’s not a good measure and I wonder really how accurate this is.

Dave

There is something that is left out of this study, that is how much medication it takes to stay out of pain if you have chronic pain and you have been on pain medication every day for more than a year than you will need more medication to stay out of pain for the four to six hour period it dose not mean that we are going to over dose, the bottom line is there needs to be a separation between someone that brakes there arm and becomes addicted to pain medication and someone that has chronic pain, unless you live in your shoes day in and day out you will not understand. Thanks Dave

Debbie Nickels Heck, MD

I’m skeptical. People are still individuals and perceive pain differently. I’d want to have BOTH the so-called “objective EEG test measure” compared with what the patients state as their perceived level of pain at the same time, not based on the visual analogue scale but on the numbered scale which is something more patients relate to. It would give a comparison more similar to a “placebo controlled test,” so to speak, to see how it compares at the same time.

Adam

I’m sorry to have read this. I wasn’t prepared for a description of the medical community’s animal abuse. STOP! Find a better way to do your testing!