Holmes Scott Alexander, Mar'i Joud, Green Stephen, Borsook David
Boston Children's Hospital, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, MA 02115, USA.
Pain and Affective Neuroscience Center, Boston Children's Hospital, USA.
Neurobiol Pain. 2022 Nov 4;12:100108. doi: 10.1016/j.ynpai.2022.100108. eCollection 2022 Aug-Dec.
As our definition of pain evolves, the factors implicit in defining and predicting pain status grow. These factors each have unique data characteristics and their outcomes each have unique target attributes. The clinical characterization of pain does not, as defined in the most recent IASP definition, require any tissue pathology, suggesting that the experience of pain can be uniquely psychological in nature. Predicting a persons pain status may be optimized through integration of multiple independent observations; however, how they are integrated has direct relevance towards predicting chronic pain development, clinical application, and research investigation. The current challenge is to find clinically-mindful ways of integrating clinical pain rating scales with neuroimaging of the peripheral and central nervous system with the biopsychocial environment and improving our capacity for diagnostic flexibility and knowledge translation through data modeling. This commentary addresses how our current knowledge of pain phenotypes and risk factors interacts with statistical models and how we can proceed forward in a clinically responsible way.
随着我们对疼痛的定义不断演变,定义和预测疼痛状态中隐含的因素也在增加。这些因素各自具有独特的数据特征,且它们的结果各自具有独特的目标属性。正如最新的国际疼痛研究协会(IASP)定义中所明确的那样,疼痛的临床特征并不需要任何组织病理学依据,这表明疼痛体验在本质上可能具有独特的心理性。通过整合多个独立观察结果,或许能够优化对一个人疼痛状态的预测;然而,这些观察结果的整合方式与预测慢性疼痛的发展、临床应用以及研究调查直接相关。当前的挑战在于找到兼顾临床实际的方法,将临床疼痛评定量表与外周和中枢神经系统的神经影像学以及生物心理社会环境相结合,并通过数据建模提高我们的诊断灵活性和知识转化能力。本评论探讨了我们目前对疼痛表型和风险因素的认识如何与统计模型相互作用,以及我们如何以对临床负责的方式向前推进。