By Martha Farah, Director, University of Pennsylvania Center for Neuroscience & Society
Neurolaw includes some fascinating issues that lack any practical legal significance – for example whether we should consider anyone responsible for anything they do, given that all behavior is physically caused by brain processes. It also includes some legally important issues that lack intellectual juiciness – like regulatory issues surrounding neurotechnology.
Thank goodness there are also some issues that combine intellectual fascination with practical legal importance. The Petrie-Flom Center at Harvard Law School and the Center for Law, Brain & Behavior at Massachusetts General Hospital recently focused on just such an issue when they convened a meeting of neuroscientists and legal scholars on the brain imaging of pain.
Pain, I learned at this meeting, is at the heart of many legal proceedings. A major problem to be solved in these proceedings is the determination of whether someone is truly in pain. Chronic pain in particular may not have physically obvious causes. There may be clinical and circumstantial evidence of pain – like adhering to a medication regime, seeking surgeries or other interventional procedures, and avoiding pleasurable activities – but often the major evidence of pain is just what someone says that it is. However, the motivation exists to lie about pain – to sue for more money, to obtain disability benefits – and so an objective measure of pain, a “pain-o-meter,” would be helpful.
The “pain-o-meter” is a silly term for a serious idea: the idea of using neuroimaging to assess the likelihood that someone is in pain. In principle it seems pretty straightforward: validate and norm the imaging measures (functional and structural), compare the patient’s values on those measures to the norms, and see how pain-like their values are. Alas, in presentations by an eminent line-up of pain neuroscientists, we learned how far away we currently are from having such validation. Continue reading »