Is There a Better Way to Measure Pain?

Everyone would like to develop a more accurate way of quantifying pain. Today, we usually ask patients to rate their pain on a scale of 0-10. Some people believe that we need objective measurements.

Dr. Julia Finkel, an anesthesiologist based in Washington, D.C., and her team are seeking FDA approval on an experimental device that might more objectively measure pain. According to Dr. Finkel, this technology measures “reactions in the patient’s pupil to light and non-painful stimulation of particular nerves.” She hopes this will provide information about the best way to manage a patient’s pain.

As I told Larry Mantle of KPCC‘s “Airtalk,” the National Institutes of Health (NIH) must have found potential in Julia Finkel’s work if they are encouraging her research. Pupils may react to acute pain. However, I am skeptical about the potential for this device to accurately assess the level of chronic pain for several reasons.

Chronic pain is a product of the brain. Pain is a perception that integrates cognition, mood, beliefs, experience, and expectations among other things. It is hard to imagine how an autonomic response of a pupil will integrate all of these inputs. In addition, certain medications that people in chronic pain take may also cause changes to the pupils. I don’t understand how a clinician can sort out pain from all the other factors that can influence a pupil’s diameter. Maybe I will be shown someday.

While I’m not sure what Dr. Finkel’s research will yield, I am aware of new medical innovations that show some promise.

Developing Technologies May Treat Pain

For example, Virtual Reality Neuropsychological Therapy (VRNT) is one of dozens of Virtual Reality (VR) technologies that are currently under development for helping chronic pain patients. Whereas other VR technologies may provide temporary benefits, VRNT trains the brain to process pain differently. Through repeated applications of VRNT, patients can expect to receive pain relief for extended time periods. This may reduce their dependence on painkillers. I am part of the team that is helping to evaluate the VRNT experience.

VR is already proving its potential for helping improve the experiences for children at hospitals nationwide including the Lucile Packard Children’s Hospital Stanford in Connecticut. Through the Chariot Program, pediatric patients use VR headsets, tablets, and other mobile technologies to reduce their anxiety. According to Sam Rodriguez, MD, of Lucile Packard Children’s Hospital Stanford, these innovations sometimes allow doctors “to decrease the amount of sedatives, pain medication and even anesthesia” patients require.

Sana Health is exploring technology to treat pain and sleep disorders with stimulation from light and sound. This innovative technology uses a device that looks like ski goggles to deliver their proprietary pattern of light and sound. It presumably works by neuromodulation and retraining the brain similar to the way in which VRNT technology does.

Pear Therapeutics developed a digital treatment for opioid use disorder by providing interactive cognitive behavioral therapy. The FDA approved the technology last year. They have several other digital platforms for diseases that they are developing.

Hope of Better Treatments for Pain Patients

These are some of the exciting innovations that may provide more efficient and less costly methods to treat many medical problems including opioid use disorder and chronic pain. Knowing about these technologies should provide patients reason for hope. The digital world has clearly arrived in clinical medicine.