Innovative Biomarker Tool for Chronic Pain Assessment
Highlight from the 2nd Annual Spine 10 x 25 Summit: Technology Update
At the 2nd Annual Spine 10 x 25 Summit: Technology Update, David B. Ross, MD, presented his innovative new pain assessment tool, The Neurophysiologic Pain Profile (NP3). Dr. Ross, a neurologist who treats many patients with chronic pain, well understands the clinical need for assessment tools that pinpoint the source of a patient’s spine-related pain. “The Neurophysiologic Pain Profile, combined with other standard technology and tools, provides unprecedented data that lets patients and physicians know what is necessary for each individual,” he stated.
One hundred million Americans have subacute or chronic pain. If current trends continue, 30% of all 20 year-olds will become disabled before age 65. Spinal pain is the most common cause of the disability epidemic in the US. Dr. Ross noted these statistics continue to rise in spite of advances in medical technology. “Over my career, I’ve seen a huge growth in our ability to be more accurate in terms of spinal anatomy and neurodiagnostic techniques,” he said. He described advances such as better imaging techniques, improvements in surgical procedures (eg, minimally invasive surgery), diagnostic and therapeutic injections, new medications, and multidisciplinary pain programs. “But the problem is getting worse, “Dr. Ross continued, “and the question then must be, why?”
Dr. Ross noted that standard medical training does not prepare clinicians well for dealing with pain. “Pain has proven to be complex,” he notes. “It is personal, subjective, and multifactorial.” While medical training focuses on anatomy and anatomically-based diagnoses, anatomy often does not match pain or dysfunction in patients with spine-related pain. Furthermore, patients with the same diagnosis vary greatly in their presentation and their response to treatment. Dr. Ross stated, “Pain is tissue pain generators—muscle, nerve, bones and joints—mixed with emotions and cognitions to create a brain-based experience.”
Understanding pain as multifactorial and brain-based, Dr. Ross reported that he wondered how we can better meet patients’ needs. “What if we could really understand, not guess or predict what an individual needs? We would know when to give the patient injections or recommend surgery for a painful disc or joint, when to continue treating unresponsive muscle tenderness, when to address fear avoidance and depression, and how to use opioids wisely, and how often,” he said. The result would be better outcomes, reduced absenteeism, and less social disengagement. “And maybe we can turn the tide on this growing social and economic burden of spinal disability," he said.
Dr. Ross and his team developed the Neurophysiologic Pain Profile with these goals in mind. The NP3 is an assessment tool that pinpoints the source of pain, differentiating between physical sensory, emotional, and sociodynamic sources. Physical sensory pain generators are in the tissues: muscles, joints, and nerves, for example. Emotional sources of pain are biological reactions associated with fear, anxiety, depression, or other mental states. Sociodynamic factors that increase the pain experience include culture, past experiences, and other external stressors.
Dr. Ross reported that the NP3, based on the well-understood fight-or-flight response, is objective, unbiased and scientifically valid. “This assessment allows the physicians and case managers to identify accurately a person’s needs for pain relief so they can be addressed prior to invasive procedures that all too often result in spinal disability,” he stated.
Dr. Ross acknowledged that change takes effort and can be difficult to achieve. “We have to change our habits—physicians, healthcare providers, and patients,” he said. Habits and routine ways of doing things become ingrained from the organizational to the individual level, regardless of effectiveness. “The scope of the problem has been under-appreciated,” Dr. Ross stated, “but I truly believe the goals are achievable.”