We Can’t Measure Pain. Is That Fueling the Opioid Crisis?
Researchers are trying to invent a machine to quantify pain, but is it realistic?
According to the CDC, 91 people die every day from opioid overdoses—a problem that has become epidemic in proportion and led the Trump administration to try to solve the crisis with everything from declaring it a “public health emergency,” an ad campaign, and a messy attempt to find an opioid czar.
One way public health officials are trying to figure out how to help those suffering from opioid addiction is through a theoretical device being described as a “pain-o-meter” capable of measuring a patient’s pain objectively and accurately. The National Institutes of Health has begun evaluating proposals for $4 million in small business grants that will go towards developing some sort of technology or methodology that objectively measures pain, as part of a larger effort to help reduce the number of painkillers from being overprescribed and fueling opioid addictions.
Here's why: A patient could be suffering from anything between mild discomfort and irascible torture, but an opioid painkiller is almost certainly going to provide some relief. The dose, however, should vary—but often does not, leading to some people to get addicted to drugs that might have been way too powerful for their pain needs.
The current system leaves much to be desired in terms of scientific accuracy: Doctors simply ask patients to rate their pain on a numerical scale or something similar, and use that information to determine what kind of painkiller prescription would work best.
“Pain assessment heavily relies on self-report of pain,” Dr. Dave Thomas, a Health Scientist Administrator at the National Institute on Drug Abuse (NIDA), told The Daily Beast. “Whereas how a person describes their pain is important to know, there are some issues with using self-report measures to do science or diagnose the causes and best treatment of pain.”
The problem with pain is that it’s person-specific. Someone with little experience with pain might be more prone to citing their pain on higher levels of a numerical scale, while another person who’s used to a similar kind of pain would underrate it. Some individuals naturally possess a stronger tolerance to pain, while others may be more sensitive due to their genetics.
Thomas, NIDA’s representative to the NIH Pain Consortium, says an ideal version of the pain-o-meter wouldn’t simply measure pain levels objectively, but also forecast if opioids are useful in helping a person's pain in the first place. That means doctors only give a patient what they need—no more, no less.
“This would cut down on opioid prescriptions that do not help and are not used,” Thomas said, reducing the number of prescription painkillers being sold on the streets.
To that end, a pain-o-meter could be anything from a blood test that determines patient pain, to a device that observes physical signs of pain like pupil dilation or muscular stress, to intelligent software capable of looking at a patient’s response to pain and assessing what that pain is on a quantifiable scale. Other factors could include measuring brain activity, immune system functions, gene signaling that results from pain, and more overt behavioral changes.
It’s critical to note that the pain-o-meter is just one of several solutions public health officials are pursuing to tackle opioid addiction. The president’s commission on combating the opioid crisis found, like many experts have, that the pharmaceutical industry has too aggressively marketed opioids to doctors looking for a solution to patient reports of pain, and that health insurance companies are incentivizing opioid prescriptions as a cheaper alternative to other treatments that could allegiant pain.
But is it realistic to expect a pain-o-meter to work, much less exist?
Dr. John Farrar, a professor of epidemiology at the Hospital of the University of Pennsylvania, is a bit skeptical a pain-measuring device would really put a significant dent in the opioid crisis. “The treatment of patients with pain are a small percentage of people who end up with problems with addiction to opioids,” he told The Daily Beast. He’s not quite sold on how well such a tool could clamp down on the number of prescription opioids making their way through communities.
Furthermore, he’s not quite sure it would ever be possible to properly gauge pain in a patient using a pain-o-meter of some kind. “Pain is 100 percent subjective,” he continued. “The only way we’re going to know about whether a patient has pain is by asking.” Too many factors play into how a person experiences pain, and Farrar believes that, currently, “the concept of there being a device [to measure pain with complete accuracy] is overly optimistic...I would argue that that simply is not possible.”
Regardless, there seems to be a consensus that physicians and researchers can do more in this field to help patients. “People in pain do get frustrated,” Thomas said. “They are frustrated for many reasons, mostly around not getting adequate pain relief. And they are frustrated when they are questioned and doubted about the pain they report.”
That doesn't mean Thomas believes a pain-o-meter would be a catch-all for figuring out pain reports. Rather, he envisioned it as a way to help the medical community figure out how to best treat pain. “With the better picture of pain provided by self-report and objective measures, better diagnosis may be achieved, better treatment courses may be followed and better research may be conducted,” he said.