For centuries, doctors have pretty much relied on a universal, and incredibly flawed, technique to diagnose a patient’s pain: “One a scale of 1 to 10, how bad does it hurt?”
Now the Army’s looking to upend that archaic strategy entirely, by developing a system that gives doctors an exact measurement of just how intense a patient’s pain actually is. In their latest call for research proposals, the Army’s Medical Research and Material Command asking for an “Objective Method for Pain Detection/Diagnosis,” that would take a soldier’s own assessment of their discomfort — the current gold-standard of pain evaluation — out of the equation.
Instead, the Army envisions some kind of gadget (a biomarker measurement device or an imaging system are among the ideas they propose) that’d “measure the intensity of pain” to give docs a better idea of how aggressively they ought to treat it.
If such a device could be realized, it’d no doubt come in very handy for doctors trying to get a grasp on what kind of distress a soldier is experiencing. After all, the military’s current standards for pain assessment are much like those in the civilian world — self-reported ratings, along with a patient’s nebulous descriptions of aches, stabs and twinges. Unfortunately, statements like “It hurts really bad,” and “it kind of throbs,” aren’t particularly helpful. Especially given that pain thresholds and perceptions differ markedly between patients. But the system would be even more essential, the Army notes, when soldiers “cannot reasonably ‘self-report’,” because they’re too traumatically injured or too sedated to speak up.
An objective pain detector, of course, would likely be used with marked frequency among soldiers in Iraq and Afghanistan, where acute and chronic pain have become increasingly common, especially among those ravaged by several deployments. One 2009 survey of soldiers evacuated with injuries from Iraq found that 60 percent ranked their pain as “severe.” And with more soldiers than ever surviving initial wounds, more of them are coping with the pain accompanying injuries that used to be fatal.
Soldiers are also, as Army brass have admitted, being overmedicated where pain relief is concerned — a problem that has increasingly led to dependency and even fatal overdoses. In 2009, for example, military docs wrote 3.8 million prescriptions for painkillers, which marked a fourfold increase in those prescriptions compared to 2001. Even worse, 25 percent of soldiers admitted to abusing prescription drugs (mostly painkillers) in an Army survey distributed that same year. So being able to determine whether an injured soldier really needs that morphine, and how much of it, might help Army docs prevent at least some of the troubling issues associated with narcotic painkillers and ailing soldiers.
That said, a device capable of objective pain detection is much, much easier said than done. Researchers have been touting new methods of objective pain diagnosis for decades, including zany methods like thermography (using a scan of body heat to assess pain) and the Emotional Freedom Technique (tapping certain points on the body to spot discomfort). Not surprisingly, none of those approaches have panned out. But more recent work, including a brain-scanning technique developed by Stanford scientists last year and biomarkers being investigated at Massachusetts General Hospital, seem extremely promising. That said, they’re also still in the early stages.
And if none of those prospects work, Danger Room’s got at least one suggestion for another expert in the field. His name is Sting. And he is, undisputedly, the king of pain. (Also: the king of this reporter’s heart.)
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