image: Over 70% of chronic pain cases are women. Effective treatment of pain has been hampered by an entirely subjective protocol for measuring pain severity, with variation introduced in patient assessments and physician biases.
Credit: Arocamora, CC BY-SA 4.0
Chronic pain affects millions of people, and women tend to experience more severe and frequent pain compared to men. In fact, over 70% of chronic pain cases are women. Yet measuring and managing pain is often a complex challenge. There is no objective way to quantify pain to effectively tailor treatment, and there are significant variations in how patients experience it and how physicians respond to it. A new research effort is hoping to change that.
Tufts University, with outside collaborators, has been selected by the Advanced Research Projects Agency for Health (ARPA-H) as an awardee of the Sprint for Women’s Health to develop new technologies to quantitatively measure pain in patients to improve care and accelerate the development of new treatments. The team will receive $3.03 million in funding over two years.
Chronic pain may be caused by inflammation, damaged neurons, or conditions like fibromyalgia. Each type may require a different treatment approach. Regardless of its source, pain can be very subjective, depending on psychological, social, and other factors. While elite athletes and soldiers may train themselves to withstand high levels of pain, reaction to pain can vary greatly for anyone who experiences it.
Standard practice in assessing pain in the clinical setting is entirely subjective—something most of us have experienced if we have been asked to measure it on a chart using smiling to frowning emoticons.
Subjectivity in assessing pain is not just on the patient side. Bias also occurs on the treatment side, with some minority groups being undertreated for managing pain compared to the general population.
“Having an objective quantitative tool to assess pain will help to remove these subjective variables and provide a more rational basis for treatment,” said Sameer Sonkusale, professor of electrical and computer engineering at the Tufts School of Engineering and principal investigator on the project, which includes collaborators from the Uniformed Services University of Health Sciences (USU), The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF) and Northwestern Medicine.
The research team’s approach will involve screening over 30 biomarkers, such as stress hormones, inflammation markers, and neurotransmitters in the interstitial fluid that moves between cells in the skin. Another monitor will track responses such as heart rate fluctuations, galvanic skin response, and breathing.
These biomarkers were identified in earlier studies as linked to a patient’s experience of pain, but this is the first effort to create a composite panel of markers to generate a quantitative score for pain.
The biomarker data will be merged with answers to pain questionnaires collected from women at several sites including the Defense and Veterans Center for Integrative Pain Management and Northwestern Medicine. Shuchin Aeron, associate professor of electrical and computer engineering at Tufts will apply artificial intelligence and machine learning to combine these factors into an objective and quantitative pain score.
The researchers will narrow the panel down to five or more of the most reliable pain-linked biomarkers, which can be monitored on a portable, wearable device for both clinical site and remote pain assessment. The results would instantly be reported to the physician or to the patient on a smartwatch or smart ring.
The availability of such devices would not only improve pain management, but could also accelerate the development of new drugs and treatments, which could benefit from an objective measure of their effectiveness
“While pain reporting is subjective and dependent on many extraneous factors, for the same level of pain, the measurable physiological markers and signals are expected to be similar from one individual to the next,” said Sonkusale. “Considering an observed gender bias in the prevalence and approach to treatment of chronic pain, this technology addresses a large unmet medical need for women, creating a path to more effective pain management.”
“It has been extremely challenging to objectively quantify nociplastic pain—the type of pain involving nervous system sensitization in conditions like fibromyalgia that are quite common in women. This study could provide a way to objectively quantify pain in a way that will greatly help in their treatment,” said Steven P Cohen, Edmond I Eger Professor of Anesthesiology and Pain Medicine at Northwestern Medicine.
ARPA-H sought solutions within six topics of interest in women's health. The Sprint for Women’s Health launched in February.
In addition to Sonkusale, Aeron and Cohen, the research team will include Manish Bhomia (Assistant Professor of Pathology, USU), Kalyn Jannace (Senior Scientist, USU), Barbara Ritschel (Professor of Pathology, USU) and Xiaoning Yuan (Assistant Professor Physical Medicine and Rehabilitation & Vice Chair for Research, USU), and Stacey Harcum (Senior Operations Manager, HJF).