Objective assessment of pain syndrome: efficacy of physiological, biochemical, and neuroimaging diagnostic methods

Abstract

Contemporary research in the field of objective pain assessment represents a dynamically evolving direction that integrates diverse methodological approaches. In clinical practice, traditional diagnostic methods based on subjective patient reports and analysis of autonomic responses demonstrate limited reliability due to their non-specificity and dependence on numerous confounding factors. In this context, the development of comprehensive algorithms capable of providing reliable diagnosis of not only the presence of pain but also its intensity, localization, and pathophysiological mechanisms is of particular relevance.

Currently, four main strategies can be identified for objective pain assessment. The first group of methods is based on the analysis of changes in the autonomic nervous system, including heart rate variability, the surgical plethysmographic index, skin conductance, and pupillometry. The second strategy involves the study of bioelectric potentials using electroencephalography, electrocardiography, and electromyography. The third direction is associated with the application of neuroimaging technologies, such as functional magnetic resonance imaging and positron emission tomography. The fourth group of methods is focused on identifying biological markers, including stress hormones, pro-inflammatory cytokines, and neuropeptides.

The problem of pain assessment in neonatology deserves special attention, where traditional approaches prove to be poorly informative. For newborns, especially preterm infants, research into non-invasive biomarkers and their interpretation considering gestational age and metabolic peculiarities appears promising.

Despite significant progress in the field of nociception assessment, none of the existing methods can be recommended as a universal diagnostic tool. The most promising direction seems to be the development of comprehensive algorithms integrating several diagnostic approaches and allowing compensation for the limitations of individual methods. The implementation of this task could open new opportunities for personalized diagnosis and therapy of pain syndromes in various clinical situations.