J Pain. 2013 Apr;14(4):323-7. doi: 10.1016/j.jpain.2012.05.007.
Arguments made for the advantages of replacing pain ratings with brain-imaging data include assumptions that pain ratings are less reliable and objective and that brain image data would greatly benefit the measurement of treatment efficacy. None of these assumptions are supported by available evidence. Self-report of pain is predictable and does not necessarily reflect unreliability or error. Because pain is defined as an experience, magnitudes of its dimensions can be estimated by well-established methods, including those used to validate brain imaging of pain. Brain imaging helps to study pain mechanisms and might be used as proxy measures of pain in persons unable to provide verbal reports. Yet eliminating pain ratings or replacing them with neuroimaging data is misguided because brain images only help explain pain if they are used in conjunction with self-report. There is no objective readout mechanism of pain (pain thermometer) that is unaffected by psychological factors. Benefits from including neuroimaging data might include increased understanding of underlying neural mechanisms of treatment efficacy, discovery of new treatment vectors, and support of conclusions derived from self-report. However, neither brain imaging nor self-report data are privileged over the other. The assumption that treatment efficacy is hampered by self-report has not been shown; there is a plethora of treatment studies showing that self-report is sensitive to treatment. Dismissal of patients' self-reports (pain ratings) by brain-imaging data is potentially harmful. The aim of replacing self-report with brain-imaging data is misguided and has no scientific or philosophical foundation.
Although brain imaging may offer considerable insight into the neural mechanisms of pain, including relevant causes and correlations, brain images cannot and should not replace self-report. Only the latter assesses the experience of pain, which is not identical to neural activity. Brain imaging may help to explain pain, but replacing self-report with brain-imaging data would be philosophically and scientifically misguided and potentially harmful to pain patients.
用大脑成像数据替代疼痛评分的优势论点包括这样的假设，即疼痛评分不太可靠和客观，而大脑图像数据将极大地有益于治疗效果的测量。这些假设都没有得到现有证据的支持。疼痛的自我报告是可预测的，并不一定反映不可靠或错误。由于疼痛被定义为一种体验，其维度的大小可以通过既定的方法进行估计，包括用于验证疼痛的大脑成像的方法。大脑成像有助于研究疼痛机制，并且可以用作无法提供口头报告的人的疼痛替代指标。然而，消除疼痛评分或用神经影像学数据替代它们是有误导性的，因为只有在将大脑图像与自我报告结合使用的情况下，它们才能帮助解释疼痛。目前还没有不受心理因素影响的疼痛客观读数机制（疼痛温度计）。纳入神经影像学数据的好处可能包括对治疗效果的潜在神经机制的理解的增加，新的治疗向量的发现，以及对来自自我报告的结论的支持。然而，大脑图像和自我报告数据都没有优于另一个。治疗效果因自我报告而受阻的假设尚未得到证实；有大量的治疗研究表明自我报告对治疗敏感。通过大脑成像数据否定患者的自我报告（疼痛评分）可能是有害的。用大脑成像数据替代自我报告的目的是有误导性的，没有科学或哲学基础。
尽管大脑成像可能为疼痛的神经机制提供相当大的洞察力，包括相关的原因和相关性，但大脑图像不能也不应该替代自我报告。只有后者评估疼痛的体验，而这与神经活动并不相同。大脑成像可能有助于解释疼痛，但用大脑成像数据替代自我报告在哲学和科学上是有误导性的，并且可能对疼痛患者造成伤害。
