I have a PhD in neuroscience, where I studied circadian rhythm disruption and its effect on pain behavior. So I feel qualified to discuss this.
In humans, pain has two primary components [0]:
1. The sensory-discriminative component: where on my body, what type (hot? cold? chemical?), and how intense is the noxious stimulus?
2. The affective-emotional component: how much does the pain hurt, and how does it affect emotional state?
Very importantly, both #1 and #2 are considered “pain”, and they can be experienced both simultaneously and independently. Pain is entirely subjective, as TFA highlights.
It does sound valuable to search for biomarkers of the sensory-discriminative component. But I’m doubtful that biomarkers for #2 are readily observable, beyond fMRI. The “Nociometer” may capture this, but what if it doesn’t in a reliable way, since it’s designed to test #1? TFA discussed how this could save money for health-care system money; this gives me an awful feeling.
Relying on “biomarker-based pain measurements” worries me that patients who are primarily experiencing affective-emotional components of pain will only further be doubted or not trusted by physicians.
There are already far, far too many examples of physicians not trust patients about pain. Re: women at Yale undergoing IVF treatments without fentanyl injections due to a drug misusing nurse stealing the fentanyl. Physicians responded to the unanesthetized women in excruciating pain by saying, “maybe you are immune to fentanyl!” [1*].
I think we should tread lightly.
—
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC6676053/
[1] https://www.nytimes.com/2024/09/09/health/yale-ivf-egg-retri...
*There is a heart breaking podcast on this scandal, which is how I originally learned about it [2]. Of course when I was in horror telling my wife about the story, the news came as no surprise to her, as she’s experienced pain disbelief from physicians her entire life.
[2] https://www.thisamericanlife.org/804/the-retrievals
In humans, pain has two primary components [0]:
1. The sensory-discriminative component: where on my body, what type (hot? cold? chemical?), and how intense is the noxious stimulus?
2. The affective-emotional component: how much does the pain hurt, and how does it affect emotional state?
Very importantly, both #1 and #2 are considered “pain”, and they can be experienced both simultaneously and independently. Pain is entirely subjective, as TFA highlights.
It does sound valuable to search for biomarkers of the sensory-discriminative component. But I’m doubtful that biomarkers for #2 are readily observable, beyond fMRI. The “Nociometer” may capture this, but what if it doesn’t in a reliable way, since it’s designed to test #1? TFA discussed how this could save money for health-care system money; this gives me an awful feeling.
Relying on “biomarker-based pain measurements” worries me that patients who are primarily experiencing affective-emotional components of pain will only further be doubted or not trusted by physicians.
There are already far, far too many examples of physicians not trust patients about pain. Re: women at Yale undergoing IVF treatments without fentanyl injections due to a drug misusing nurse stealing the fentanyl. Physicians responded to the unanesthetized women in excruciating pain by saying, “maybe you are immune to fentanyl!” [1*].
I think we should tread lightly.
—
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC6676053/
[1] https://www.nytimes.com/2024/09/09/health/yale-ivf-egg-retri...
*There is a heart breaking podcast on this scandal, which is how I originally learned about it [2]. Of course when I was in horror telling my wife about the story, the news came as no surprise to her, as she’s experienced pain disbelief from physicians her entire life.
[2] https://www.thisamericanlife.org/804/the-retrievals