Machine learning–based prediction of clinical pain using multimodal neuroimaging and autonomic metrics


Lee J, Mawla I, Kim J, Loggia ML, Ortiz A, Jung C, Chan S-T, Gerber J, Schmithorst VJ, Edwards RR, Wasan AD, Berna C, Kong J, Kaptchuk TJ, Gollub RL, Rosen BR, Napadow V. Machine learning–based prediction of clinical pain using multimodal neuroimaging and autonomic metrics [Internet]. PAIN 2019;160
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Although self-report pain ratings are the gold standard in clinical pain assessment, they are inherently subjective in nature and significantly influenced by multidimensional contextual variables. Although objective biomarkers for pain could substantially aid pain diagnosis and development of novel therapies, reliable markers for clinical pain have been elusive. In this study, individualized physical maneuvers were used to exacerbate clinical pain in patients with chronic low back pain (N = 53), thereby experimentally producing lower and higher pain states. Multivariate machine-learning models were then built from brain imaging (resting-state blood-oxygenation-level-dependent and arterial spin labeling functional imaging) and autonomic activity (heart rate variability) features to predict within-patient clinical pain intensity states (ie, lower vs higher pain) and were then applied to predict between-patient clinical pain ratings with independent training and testing data sets. Within-patient classification between lower and higher clinical pain intensity states showed best performance (accuracy = 92.45%, area under the curve = 0.97) when all 3 multimodal parameters were combined. Between-patient prediction of clinical pain intensity using independent training and testing data sets also demonstrated significant prediction across pain ratings using the combined model (Pearson's r = 0.63). Classification of increased pain was weighted by elevated cerebral blood flow in the thalamus, and prefrontal and posterior cingulate cortices, and increased primary somatosensory connectivity to frontoinsular cortex. Our machine-learning approach introduces a model with putative biomarkers for clinical pain and multiple clinical applications alongside self-report, from pain assessment in noncommunicative patients to identification of objective pain endophenotypes that can be used in future longitudinal research aimed at discovery of new approaches to combat chronic pain.Corresponding author. Address: Martinos Center for Biomedical Imaging, Building 149, Suite 2301, Charlestown, MA 02129, United States. Tel.: +1-617-724-3402; fax: +1-617-726-7422. E-mail address: (V. Napadow).Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site ( Lee and I. Mawla contributed equally to this work.Received July 13, 2018Accepted October 09, 2018© 2018 International Association for the Study of Pain

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Last updated on 03/22/2019