Molecular Psychiatry (2019): Towards precision medicine for pain: diagnostic biomarkers and repurposed drugs

An objective biomarker - gene expression patterns - for pain? Can this be true?

https://www.nature.com/articles/s41380-018-0345-5 (A.B Niculescu et al.) Full text.

The cohorts and the scientists are psychiatric patients/psychiatrists but otherwise the study seems to lean more biomedical - not a single mention of CBT - and recognition of different types of pain other than Central Sensitisation.

Finishes with a bit of hype though:

 

That's an odd choice considering you can barely whack around a pool noodle without hitting dozens of non-psychiatric chronic pain patients desperately willing to try anything to make the pain go away and ready to participate in research right now.

The study seems on the serious side but I strongly question motive when such an odd choice is made. That's as bad as including major depressive disorder and somatization patients in PACE, it just adds way too much distortion by choice, making interpretation more difficult than it should be.

Hammers just can't quit thinking about nails.

 

Consent?

 

Going on memory here so could be wrong but I think it was a matter of convenience. They just happened to have these patients handy from another study or something along those lines, possibly even with some useful historical data available. (@Amw66 consent was discussed in the paper but can't recall the details now).

The authors discussed the matter that most of their patients had a merry mix of comorbidities, both psychological and physiological, and viewed that as a strength. They wanted a biomarker for pain that shows up no matter what underlying condition/s a patient is suffering from. Sensible enough provided all types of pain create the same gene expression pattern, or at least fit a small number of distinct gene expression patterns. They found at least 2 and possibly up to 8 subgroups. That's where I'm a bit dubious. Were their cohorts large enough to say something about that many subgroups with reasonable certainty?