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Nat Rev Neurol. 2017 Oct;13(10):624-638. doi: 10.1038/nrneurol.2017.122. Epub 2017 Sep 8.

Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations.

Author information

1
Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Room MP12-306, Toronto, Ontario M5T 2S8, Canada.
2
Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada.
3
Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.
4
Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Ruprecht-Karls-Universität Heidelberg, J5, D-86169 Mannheim, Germany.
5
Stanford Program in Neuroscience and Society, Center for Law and the Biosciences, Stanford Law School, Stanford University, Stanford, California 94305-8610, USA.
6
Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, UK.
7
Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero, Suite 200, Palo Alto, California 94304, USA.
8
Department of Neurology and TUM-Neuroimaging Center, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
9
Center for Law, Brain &Behavior, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA.
10
University of Maryland School of Law, 500 W. Baltimore Street, Baltimore, Maryland 21201, USA.
11
Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK.
12
Center for Biomedicine and Medical Technology Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-17, 68167 Mannheim, Germany.
13
Department of Psychology and Neuroscience, Muezinger D244, 345 UCB, Boulder, Colorado 80309-0345, USA.
14
Institute of Cognitive Science, University of Colorado, 344 UCB, Boulder, Colorado 80309-0344, USA.

Abstract

Chronic pain is the greatest source of disability globally and claims related to chronic pain feature in many insurance and medico-legal cases. Brain imaging (for example, functional MRI, PET, EEG and magnetoencephalography) is widely considered to have potential for diagnosis, prognostication, and prediction of treatment outcome in patients with chronic pain. In this Consensus Statement, a presidential task force of the International Association for the Study of Pain examines the capabilities of brain imaging in the diagnosis of chronic pain, and the ethical and legal implications of its use in this way. The task force emphasizes that the use of brain imaging in this context is in a discovery phase, but has the potential to increase our understanding of the neural underpinnings of chronic pain, inform the development of therapeutic agents, and predict treatment outcomes for use in personalized pain management. The task force proposes standards of evidence that must be satisfied before any brain imaging measure can be considered suitable for clinical or legal purposes. The admissibility of such evidence in legal cases also strongly depends on laws that vary between jurisdictions. For these reasons, the task force concludes that the use of brain imaging findings to support or dispute a claim of chronic pain - effectively as a pain lie detector - is not warranted, but that imaging should be used to further our understanding of the mechanisms underlying pain.

PMID:
28884750
DOI:
10.1038/nrneurol.2017.122

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