Neuroethical issues in adopting brain imaging for personalized chronic pain management: Attitudes of people with lived experience of chronic pain

Pain is an individual and subjective experience that places a burden on individuals to convince others they have pain. Brain imaging technologies can potentially inform pain management but raise neuroethical questions. We examined the degree of endorsement and concerns of adults in Canada with chronic pain regarding the use of brain imaging to detect and treat chronic pain in six areas: new brain imaging technologies, brain data privacy, stigma, treatment, objective representations of pain, and dismissing pain self-reports. An online survey was completed by 349 Canadian adults living with chronic pain. Most respondents were open to using brain imaging for diagnostics, prediction, and therapeutic decision making (>90%). More than half of respondents felt that a brain scan would give them more confidence in their diagnosis and treatment plans and that health care providers would be more likely to believe they had chronic pain. However, they worried that brain scans could be used to dismiss their pain self-report. Most respondents felt there were policies to protect their brain data, but 40% were concerned about privacy and brain scan use against them by their employers/insurers. Although most respondents felt that a brain scan could represent their pain and suffering, 80% disagreed that their pain is only real if seen in a brain scan. People with chronic pain recognize the potential benefits of brain imaging but are concerned about data security and dismissal of their self-reported pain. Our data align with previous recommendations to use brain imaging as an adjunct to pain self-reports but not as a replacement for the same.

疼痛是一种个体化的主观体验，个体往往需要耗费大量心力去说服他人确认自身正经受疼痛症状。脑成像（brain imaging）技术有望为疼痛管理提供决策支持，但同时也会引发神经伦理学（neuroethics）相关的争议问题。本研究针对加拿大慢性疼痛成年群体展开调研，考察其对使用脑成像技术检测与治疗慢性疼痛的认可程度与担忧维度，涵盖六大领域：新型脑成像技术、脑数据隐私、污名化、治疗方案、疼痛的客观表征，以及对疼痛自我报告的否定。本次调研共有349名加拿大慢性疼痛成年受试者完成在线问卷。超90%的受访者对使用脑成像技术开展诊断、病情预测与治疗决策制定持开放态度。超半数受访者认为，脑部扫描能够提升他们对自身诊断结果与治疗方案的信心，且医护人员也会更倾向于认可他们确实患有慢性疼痛。但受访者同时担忧，脑部扫描可能被用作否定其疼痛自我报告的依据。多数受访者认为当前存在保护其脑数据的相关政策，但仍有40%的人群担忧自身隐私会遭到侵犯，且雇主或保险公司可能会滥用脑部扫描结果对其产生不利影响。尽管多数受访者认可脑部扫描能够表征自身的疼痛与痛苦体验，但80%的受访者并不认同"只有在脑部扫描中可见的疼痛才是真实的疼痛"这一观点。慢性疼痛患者能够意识到脑成像技术的潜在应用价值，但同时也对数据安全以及自身疼痛自我报告被否定一事抱有深切担忧。本研究数据与既往学术建议相符，即脑成像技术应作为疼痛自我报告的辅助手段，而非完全替代方案。