Video: To Treat or Not to Treat?

One of the most difficult, and often frustrating, aspects for clinicians treating individuals with pain is that each person’s pain experience is different. Thus, an intervention that effectively relieves pain in one person may not help another.

“One thing that is common in patients with chronic pain is the variability of their outcome,” says Catherine Chong, Ph.D., from the Mayo Clinic Arizona.

Take the example of post-traumatic headache—the headache one experiences after sustaining a concussion: In some people, this pain will go away within a few days without any further treatment. In others, however, the pain will persist and become chronic. What’s worse, Chong says, “We’re still very much in the dark why some people recover quickly and others do not and eventually develop chronic headache.”

So why not just give every person with a concussion pain medication to prevent chronic headaches from developing? As Chong explains, all medications can have side effects. Therefore, giving medications to people whose pain would resolve without treatment could actually do more harm than good. Conversely, taking a wait-and-see approach with those at high risk of developing chronic headache after a concussion is problematic as treatment works best before pain becomes chronic.

To solve this challenge, Chong and her team are working to identify biological characteristics or criteria that are measurable—a biomarker signature—that would allow clinicians to predict which patients with post-traumatic headache are at high risk of their headache becoming chronic. For each individual, they are recording a wide range of factors, such as demographic characteristics, type of brain injury/concussion, characteristics of the person’s headache, and brain imaging (MRI) data.

Using machine learning approaches, they will determine which of these many factors are best able to predict a person’s prognosis for their headache pain. The goal is to identify a set of characteristics that are accurate as well as easy to assess in everyday clinical practice—for example, by using MRI procedures that most hospitals can do, not just large research facilities.

“It’s critical that we’re able to identify those folks who are going to have difficulty recovering on their own, so that we can give them early and targeted treatment,” Chong says.

Chong’s research is just one of many projects funded by the National Institute of Neurological Disorders and Stroke through the NIH Helping to End Addiction Long-term^® Initiative, or NIH HEAL Initiative^®, to identify and test biomarkers that can help predict risk of chronic pain and improve pain management for people with a variety of painful conditions. There is no one-size-fits-all solution; researchers must identify specific biomarkers for each type of chronic pain, whether that’s post-traumatic headache, as in Chong’s research; pain associated with sickle cell disease; or musculoskeletal pain in youth that can become chronic. But each biomarker signature the researchers identify can help doctors provide every person with the treatment they need to achieve their best outcome—whether that’s more intense treatment to become pain free or holding off on additional medications to avoid side effects when the pain can resolve with no or minimal intervention.

Watch Chong’s full video interview.