Insula

Radiology

Tonic (physiology)

Developmental psychology

Magnetic resonance imaging

Psychology

Neuroscience

Chemistry

Generalizability theory

Functional magnetic resonance imaging

Chronic pain

Biomarker

Biochemistry

Neuroimaging

Medicine

Physical medicine and rehabilitation

Nature Medicine

Sustained pain is a major characteristic of clinical pain disorders, but it is difficult to assess in isolation from co-occurring cognitive and emotional features in patients. In this study, we developed a functional magnetic resonance imaging signature based on whole-brain functional connectivity that tracks experimentally induced tonic pain intensity and tested its sensitivity, specificity and generalizability to clinical pain across six studies (total n = 334). The signature displayed high sensitivity and specificity to tonic pain across three independent studies of orofacial tonic pain and aversive taste. It also predicted clinical pain severity and classified patients versus controls in two independent studies of clinical low back pain. Tonic and clinical pain showed similar network-level representations, particularly in somatomotor, frontoparietal and dorsal attention networks. These patterns were distinct from representations of experimental phasic pain. This study identified a brain biomarker for sustained pain with high potential for clinical translation.

A neuroimaging biomarker for sustained experimental and clinical pain