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What reliability can and cannot tell us about pain report and pain neuroimaging.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Woo, Choong-Wan Wager, Tor D. |
| Copyright Year | 2016 |
| Abstract | In this issue of PAIN , Letzen et al. examine the test–retest reliability of functional magnetic resonance imaging (fMRI) connectivity (fcMRI) measures and self-reported pain during pain stimulation and show that fcMRI measures are less reliable than self-reported pain. This study is a valuable endeavor, and as we move toward developing and using neuroimaging-based biomarkers for clinical purposes (eg, making predictions and decisions about an individual), efforts to establish reliability and reproducibility of candidate biomarkers will become more and more critical. Based on the results, Letzen et al. concluded, and we agree, that fMRI measures are noisier than self-reported pain. This might be a big issue if we view fMRI measures as a substitute for pain ratings. However, the real value of using brain measures to study pain is not in replacing pain ratings but in serving to (1) provide a better understanding of how the brain generates and regulates pain and (2) provide ways to see and measure its component neurobiological processes. The reason that we need brain markers for pain is not that pain ratings are “flawed” in their reliability or that they are “flawed” at all, but that pain ratings reflect a complex mix of brain and psychological processes. For example, one person can report more pain than another because of differences in nociception, emotion, decision making, self-awareness, social cognition, and communicative tendencies. Because there is no single process that causes people to report more or less pain, self-reported pain provides only limited clues on what the underlying causes and what the best course of treatment might be. Many other disorders are similarly heterogeneous, and symptoms alone have not proven to be sufficient to guide effective treatment. In cancer, for example, diagnosis and treatment have progressively shifted from symptoms and overt signs to molecular subtypes that respond to tailored molecular treatments. Reliability is an important measurement property, though it is just one piece of the puzzle. Principally, reliability places constraints on the utility of a measure for assessing individual differences. However, those constraints are more subtle than it first appears. Below, we briefly elaborate on what reliability is and what constraints it does and does not place on the use of fMRI in assessment and personalized medicine. 1. Reliability: more is not always better |
| File Format | PDF HTM / HTML |
| DOI | 10.1097/j.pain.0000000000000442 |
| Alternate Webpage(s) | http://wagerlab.colorado.edu/files/papers/Reliability_Woo_Wager.pdf |
| Alternate Webpage(s) | https://canlabweb.colorado.edu/files/Reliability_Woo_Wager.pdf |
| PubMed reference number | 26645548 |
| Alternate Webpage(s) | https://doi.org/10.1097/j.pain.0000000000000442 |
| Journal | Medline |
| Volume Number | 157 |
| Issue Number | 3 |
| Journal | Pain |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Report |
