How Well Do Current Laboratory Biomarkers Inform Clinical Decision-Making in Chronic Pain Management?

Jonathan M Hagedorn, Joshua Gunn, Ryan Budwany, Ryan S D'Souza, Krishnan Chakravarthy, Timothy R Deer, Jonathan M Hagedorn, Joshua Gunn, Ryan Budwany, Ryan S D'Souza, Krishnan Chakravarthy, Timothy R Deer

Abstract

Objective: Decision-making in chronic pain patients involves a combination of subjective and objective criteria, including patient history, physical examination, imaging, and patient response to prior treatments, clinical experience, probabilities, and recognition of patterns. However, there is a distinct lack of objective laboratory biomarkers in use in routine clinical care. The objective was to review the literature to identify and describe specific biomarkers in chronic pain management.

Methods: This is a narrative review of the literature regarding the use of laboratory biomarkers in chronic pain. A librarian-assisted literature search of the PubMed, Science Direct, and Google Scholar databases was performed and resulted in 304 possible manuscripts. We included manuscripts assessing laboratory collected biomarkers from urine, serum, cerebrospinal fluid, and saliva. After screening and review of the initial literature search results, a total of 75 manuscripts were included in the narrative review.

Conclusion: The studies reviewed suggested that specific biomarkers may help identify those patients at risk of disease development and function as a prognostic indicator for disease progression and treatment response. However, additional research is necessary before specific recommendations can be made, and current clinical decision-making is modified.

Keywords: biomarkers; chronic pain; outcomes.

Conflict of interest statement

Dr Jonathan M Hagedorn reports personal fees for consulting and advisory board from Abbott, Boston Scientific, and Nevro, outside the submitted work. Dr Joshua Gunn has a patent “Methods of Diagnosing and Treating Particular Causal Components of Chronic Pain in a Patient” pending to Ethos Laboratories; and Dr Gunn is the co-founder and Chief Scientific Officer of Ethos Research & Development. Ethos R&D developed and validated a novel biomarker assay mentioned in this manuscript. Dr Timothy R Deer reports personal fees for consulting from Ethos, during the conduct of the study. The authors report no other conflicts of interest in this work.

© 2021 Hagedorn et al.

Figures

Figure 1
Figure 1
Flow Diagram of Screening and Selection Process.

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