Abstract
Chronic pain is highly prevalent, and pain medicine lacks objective biomarkers to guide diagnosis and choice of treatment. The current U.S. “opioid epidemic” is a reminder of the paucity of effective and safe treatment options. Traditional pain diagnoses according to the International Classification of Diseases are often unspecific, and analgesics are often prescribed on a trial-and-error basis. In contrast to this current state of affairs, the vision of future mechanism-based diagnoses of chronic pain conditions is presented in this non-technical paper, focusing on the need for biomarkers and the theoretical complexity of the task. Pain is and will remain a subjective experience, and as such is not objectively measurable. Therefore, the concept of “noci-marker” is presented as an alternative to “pain biomarker”, the goal being to find objective, measurable correlates of the pathophysiological processes involved in different chronic pain conditions. This vision entails a call for more translational pain research in order to bridge the gap between clinical pain medicine and preclinical science.
Highlights
As exemplified by the deleterious consequences of congenital insensitivity to pain [1], acute pain is necessary for survival and has been called a “homeostatic emotion” [2]
In contrast to nociceptive pain, which is caused by activation of peripheral nociceptors [32], neuropathic pain is due to a disease or lesion in the somatosensory nervous system itself [33]
Given that the field of biomarkers for pain conditions (“noci-markers”) is still in its infancy, the idea of basing the choice of analgesics or even disease-modifying drugs on a blood test may seem more like science fiction than science. This vision for the future of pain medicine is appealing for pain clinicians: what if in the future we were able to prescribe analgesics or disease-modifying drugs not on a trial-and-error basis, but on the basis of information given by a blood test? Once again, it has to be underlined that this would not be a measurement of the chronic pain experience itself
Summary
As exemplified by the deleterious consequences of congenital insensitivity to pain [1], acute pain is necessary for survival and has been called a “homeostatic emotion” [2]. The prevalence of chronic pain is estimated to be as high as 20%, generating high costs both at the individual and societal level [3,10]. Against this background, it is not surprising that chronic pain has been described as a public health issue [11]. The so-called opioid epidemic in the US [12,13] is a reminder of the paucity of effective, safe, and evidence-based treatment options for chronic pain. The aim of this non-technical paper is to introduce the reader to the vision of mechanism-based diagnoses of chronic pain conditions, focusing on the need for biomarkers and the theoretical complexity of the task
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