The potential use of brain imaging as a tool to predict chronic pain after surgery

Brain imaging is a powerful tool in the investigation of mechanisms underlying pain perception, both acute and chronic. To date, brain imaging has not been applied to the specific model of predicting postoperative pain or investigating its maintenance once established. However, each of the features associated with postoperative pain (psychological phenotypes, peripheral evidence of central sensitization, neuropathic-like symptoms) has been investigated using these modalities with some success. The aim of brain imaging modalities is to explain, from a neurophysiological standpoint, some of the bedside observations seen to be associated with the development of chronic postoperative pain. This understanding serves 3 main purposes. First, from an academic point of view, it offers insights into pain mechanisms in general. Second, it identifies potential targets for pharmacologic and psychological interventions to reduce the risk of conversion to chronic postoperative pain. Third, it offers the potential to monitor the effects of proposed treatments with a quantifiable, objective measure, thus ensuring treatments are doing what they are hypothesized to do.