My Imaginary Innovation: A Pain Scanner

January 20, 2012
Eric Postal, MD

There are chemicals (neurotransmitters and otherwise) central to the physiological process of pain, and I envision an imaging modality that could depict where in the body these chemicals are active.

I’m not an academician. I’m not even close to being one. The last time I tried conducting lab research, all I managed to prove was that my space in the lab would have been more productively occupied by just about anyone or anything else - an ill-tempered baboon, perhaps, or a hoarder’s collection of old junk mail.

This isn’t to say I’m without ideas. If I had a team of competent researchers at my command, I’d have no shortage of things for them to explore. I most definitely have the 1 percent of success derived from inspiration. It’s the 99 percent perspiration that eludes me. This has the happy effect of insulating me from finding out that my ideas, when fleshed out, might not actually be all that good.

Take, for instance, my would-be contribution to the world of medical imaging: The Substance-P Scan (SPS, for short). I’ll refrain from going into detail about what Substance P is, partially because it’d bore the heck out of you and partially because I was last up-to-date on the subject almost 20 years ago. For all I know, everything I learned about it has since been disproven.

The important concept is that there are chemicals (neurotransmitters and otherwise) central to the physiological process of pain, and I envisioned an imaging modality that could depict where in the body these chemicals were active. Make it a PET-tracer, make it a gadolinium-based contrast agent for MRI - whatever tickles your fancy. Three-D images then to offer up a full-body map of painful processes, with the more painful spots being brighter.

Forget about when SPS would be clinically warranted - it’d probably be quicker and easier to identify cases when it wasn’t. Patient from a multicar collision with distracting injuries: SPS will tell you all the places where they’re hurting. A mentally impaired patient is brought in and cannot provide a history, but they’re moaning and groaning, clearly having some kind of acute episode: SPS shows the smoking gun. A chronic drug-seeker tells the ER he’s having another sickle-cell crisis: Unless SPS shows something, no narcotics today!

The clinicians would love it. Every STS would give them a checklist to run down with each patient before they left the ER, lest the “rule out pneumonia” patient leave without her lumbar pain being addressed, said pain then turning out to be a new compression fracture that the clinician “missed” by not doing an exhaustive Review of Systems.

Because the more painful spots would be more intense, they’d be able to objectively grade the pain their patients were experiencing. No more of this “Patient says pain is 100 on a 10-point scale” silliness. If nothing else, the clinicians would finally be able to validly write some of their favorite histories on our requisition forms: “Pain,” and the ever-popular “R/O pain.”

I have to admit that some of my perseveration with this idea comes from a certain morbid curiosity as to how the healthcare system would handle such a game-changer. Suppose the economics of this new technology were such that every scan had overhead of $1,000; it would not be viable unless reimbursement per study was at least that high.

What would happen? Surely, the Powers That Be would be loath to overtly ration this miraculous new technique by telling the public that, no, we can’t do everything for everyone, and if you want this you’ll have to pay for it yourself. Perhaps there would be intentional bureaucratic foot-dragging to delay its approval for use, in the hope that costs would come down in the meantime. There’s a horde of evidence-based medicine types out there who could gum up the journals for years with conflicting assessments. Then again, other reimbursements could just be cut enough to free up funding to cover this new service. Remember how X-ray got unprofitable when more advanced modalities came along?

Come to think of it, maybe it’s a good thing I’m not cut out for research. If I actually managed to pull off something of this magnitude, it might just kill me to watch my brainchild sitting unused. For all you lab-rats out there, though, feel free to take this ball and run with it. You’re on your honor to throw me a bone when you make your millions.