First-in-human prediction of chronic pain state using intracranial neural biomarkers 2023, Shirvalkar et al

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Abstract
Chronic pain syndromes are often refractory to treatment and cause substantial suffering and disability. Pain severity is often measured through subjective report, while objective biomarkers that may guide diagnosis and treatment are lacking. Also, which brain activity underlies chronic pain on clinically relevant timescales, or how this relates to acute pain, remains unclear. Here four individuals with refractory neuropathic pain were implanted with chronic intracranial electrodes in the anterior cingulate cortex and orbitofrontal cortex (OFC). Participants reported pain metrics coincident with ambulatory, direct neural recordings obtained multiple times daily over months. We successfully predicted intraindividual chronic pain severity scores from neural activity with high sensitivity using machine learning methods. Chronic pain decoding relied on sustained power changes from the OFC, which tended to differ from transient patterns of activity associated with acute, evoked pain states during a task. Thus, intracranial OFC signals can be used to predict spontaneous, chronic pain state in patients.

paywalled
First-in-human prediction of chronic pain state using intracranial neural biomarkers | Nature Neuroscience

Open access from Nature newsletter link https://www.nature.com/articles/s41593-023-01338-z.epdf?sharing_token=-Osl9tu9hsndRjiSD6l9KtRgN0jAjWel9jnR3ZoTv0MxdbojJ6tBM6fd9CbRkrdicXmlSz__nOl9GDFyXDd9ltrflXAw2iFb9RQ_5xYnLRnN_2Xvyt6E8WglzAqxrehhF4nNM4hDKvuOAqizlbqpTOXoAsmIRM0My16C7wGt9Ow=
 
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Separate work by the team found that very different brain activity accompanied acute or short-term pain, such as that produced by a hot object touching the skin. The finding may explain, at least in part, why routine painkillers are less effective for chronic pain than the short stab of agony from a stubbed toe.
“Chronic pain is not just a more enduring version of acute pain, it is fundamentally different in the brain,” Shirvalkar said. “The hope is, as we understand this better, that we can use the information to develop personalised brain stimulation therapies for the most severe forms of pain.”
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I'm not sure who uses routine painkillers for the short stab of agony from a stubbed toe. Surely you'd have to plan stubbing your toe in advance, and then take the painkiller before the stubbing, just at the right time?

I'm not convinced that chronic pain is fundamentally different from acute pain, at least not all of it. I don't know that the activity of a couple of bits of the brain measured by brain implants in 8 people with chronic pain, measured while they are in their own homes versus the brain activity (possibly measured with different equipment) related to a hot object touching the skin of people in a lab are very good comparisons. It's not surprising they are different. I think there's a good chance that the brain activity related to the pain of someone with chronic arthritic bone on bone pain might look a lot like that of someone with an acute injury that causes the same sort of physical damage.

Great if the researchers have found an objective marker of pain though.
 
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Merged
NIH Director's blog: Brain signatures for chronic pain identified in a small group of individuals

"For the first time, researchers have recorded pain-related data from inside the brain of individuals with chronic pain disorders caused by stroke or amputation (phantom limb pain). A long sought-after goal has been to understand how pain is represented by brain activity and how to modulate that activity to relieve suffering from chronic pain. Data were collected over months while patients were at home, and they were analyzed using machine learning tools. Doing so, the researchers identified an area of the brain associated with chronic pain and objective biomarkers of chronic pain in individual patients.

These findings, which represent a first step towards developing novel methods for tracking and treating chronic pain, were published in Nature Neuroscience and funded by the National Institutes of Health’s Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) Initiative and the Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative."

https://www.nih.gov/news-events/new...ronic-pain-identified-small-group-individuals
 
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