Researchers develop a test that objectively measures pain biomarkers in blood

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Credit: National Pain Report

Researchers have developed a test that objectively measures pain
biomarkers in blood. The test could help physicians better treat
patients with precision medicine, and help stem the tide of the opioid
crisis.

A breakthrough test developed by Indiana
University School of Medicine researchers to measure pain in patients
could help stem the tide of the opioid crisis in Indiana, and throughout
the rest of the nation.


A study led by psychiatry professor Alexander Niculescu, MD, PhD and published in the Nature journal Molecular Psychiatry tracked hundreds of participants at the Richard L. Roudebush VA Medical
Center in Indianapolis to identify biomarkers in the blood that can
help objectively determine how severe a patient’s pain is.

 The blood
test, the first of its kind, would allow physicians far more accuracy in
treating pain — as well as a better long-term look at the patient’s
medical future.


“We have developed a prototype for a blood test that can objectively
tell doctors if the patient is in pain, and how severe that pain is.
It’s very important to have an objective measure of pain, as pain is a
subjective sensation. Until now we have had to rely on patients
self-reporting or the clinical impression the doctor has,”

 said
Niculescu, who worked with other Department of Psychiatry researchers on
the study.

 “When we started this work it was a farfetched idea. But the
idea was to find a way to treat and prescribe things more appropriately
to people who are in pain.”


During the study, researchers looked at biomarkers found in the blood
— in this case molecules that reflect disease severity. 

Much like as
glucose serves as a biomarker to diabetes, these biomarkers allow
doctors to assess the severity of the pain the patient is experiencing,
and provide treatment in an objective, quantifiable manner.

 With an
opioid epidemic raging throughout the state and beyond, Niculescu said
never has there been a more important time to administer drugs to
patients responsibly.


“The opioid epidemic occurred because addictive medications were
overprescribed due to the fact that there was no objective measure
whether someone was in pain, or how severe their pain was,” 

Niculescu
said. 

“Before, doctors weren’t being taught good alternatives. The
thought was that this person says they are in pain, let’s prescribe it.
Now people are seeing that this created a huge problem. We need
alternatives to opioids, and we need to treat people in a precise
fashion. This test we’ve developed allows for that.”


In addition to providing an objective measure of pain, Niculescu’s
blood test helps physicians match the biomarkers in the patient’s blood
with potential treatment options.

 Like a scene out of CSI, researchers
utilize a prescription database similar to fingerprint databases
employed by the FBI to match the pain biomarkers with profiles of
drugs and natural compounds cataloged in the database.


“The biomarker is like a fingerprint, and we match it against this
database and see which compound would normalize the signature,”

 said
Niculescu, adding that often the best treatment identified is a
non-opioid drug or compound. 

“We found some compounds that have been
used for decades to treat other things pair the best with the
biomarkers. We have been able to match biomarkers with existing
medications, or natural compounds, which would reduce or eliminate the
need to use the opioids.”


In keeping with the IU Grand Challenge Precision Health Initiative
launched in June 2016, this study opens the door to precision medicine
for pain.

 By treating and prescribing medicine more appropriately to the
individual person, this prototype may help alleviate the dilemmas that
have contributed to the current opioid epidemic.


“In any field, the goal is to match the patient to the right drug,
which hopefully does a lot of good and very little harm,”

 Niculescu
said.

 “But through precision health, by having lots of options geared
toward the needs of specific patients, you prevent larger problems, like
the opioid epidemic, from occurring.”


Additionally, study experts discovered biomarkers that not only match
with non-addictive drugs that can treat pain, but can also help predict
when someone might experience pain in the future helping to
determine if a patient is exhibiting chronic, long-term pain which might
result in future emergency room visits.


“Through precision medicine you’re giving the patient treatment that
is tailored directly to them and their needs,”

 Niculescu said. 

“We
wanted first to find some markers for pain that are universal, and we
were able to. We know, however, based on our data that there are some
markers that work better for men, some that work better for women. It
could be that there are some markers that work better for headaches,
some markers that work better for fibromyalgia and so on. That is where
we hope to go with future larger studies.”




The study was supported by an NIH Director’s New Innovator Award and a
VA Merit Award. Moving forward, Niculescu’s group looks to secure more
funding through grants or outside philanthropy to continue and
accelerate these studies with the hopes of personalizing the approach
even more and moving toward a clinical application.

 A self-described
longshot at the start, Niculescu said that the work his group has done
could have a major impact on how doctors around the world treat pain in
the future.


“It’s been a goal of many researchers and a dream to find biomarkers
for pain,”

 Niculescu said. 

“We have come out of left field with an
approach that had worked well in psychiatry for suicide and depression
in previous studies. We applied it to pain, and we were successful. I
give a lot of credit for that to my team at IU School of Medicine and
the Indianapolis VA, as well as the excellent environment and support we
have.”

Story source
Indiana University.

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