General Updates | Addressing the limitations of currently used tools for assessing pain in patients with SCD

Traditionally, we have relied on visual analog scales for pain. These are very limited, both for acute and chronic pain, because they don’t tell us what are the levels of pain with which patients can function, and many of them live with pain every day, and so if you just go by the visual analog scale, you would be surprised that people can live seemingly normal lives with levels of pain in the 4, 5 out of 10 range, or sometimes even more than that. So they’re quite unhelpful, although they remain commonly used. And in general, I think that measures and tools that capture the impact of pain on the patient’s daily life are more important, and also the psychological impact of pain. So there are a lot of patient-reported outcomes and pain surveys, pain questionnaires that talk about pain, the repercussions of pain on functional status of the patient and also on their psyche. So there are a lot of tools that can be used and there are increasingly incorporated into clinical trials as outcome measures. And at least this is for chronic pain. 

For acute pain, you know, it’s really still the visual analog scale that is very much used. But we all have to work at developing better biomarkers of pain that are more objective and more quantifiable. This will be very important for clinical trials because we know that when you use pain in international clinical trials particularly, this creates a lot of problems with generalizability of the results because pain perception varies across populations, pain reporting varies, and so this can limit the generalizability of a lot of results. So we definitely need better metrics and objective and quantifiable tools of pain. 

And unfortunately, there are none that are widely available right now or even validated for use in clinical care. But I can think, for instance, of neurobiological techniques. We have, for instance, MRIs, functional MRIs looking at certain particular circuitries or brain networks that are implicated in pain. And it would be interesting to image, to get a better sense of how pain is modulated centrally. And also, we know that pain is very different and acquires different valence for different patients. We know that neuropathic pain is an important component of it, and so metrics that can quantify neuropathic pain are very important. Some of the patients may have pain from leg ulcers, others from avascular necrosis. There could be opioid hyperalgesia or opioid hyperalgesia that can be central sensitization and neuroplasticity. All these components are now not captured or very, very imperfectly captured by the tools we currently have. And so we need good biomarkers of pain to be able to properly assess it.

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