Chronic pain: five things we know about causes, treatments and diagnoses

Most of us don’t think about pain until we experience it. And when we do, it usually goes away after a few days or weeks. This has been my own experience until the summer of 2023. One day I woke up and found that my arms were hurting. There was no obvious explanation, nothing I did. The pain was intense. I couldn’t do anything: drive, cook, write, or even sleep. I have always been a hearty person, I did a lot of sports, and I thought that this strange pain was just bad luck. But as weeks turned into months and no cause or treatment could be found, I began to realize that I was not alone: ​​that there was an epidemic of chronic pain going on all around me.

As my condition persisted, I began to look at what scientists knew – and still didn’t understand – about chronic pain. First of all, I was shocked to learn how little we know about its causes. But I also discovered that we are now on the cusp of a revolution that is already changing the way we think about and treat chronic pain. (Read the full article in the magazine.)

Chronic pain is not just a symptom, but a disease.

We used to think we might die IN pain, but don’t die With This. Today, chronic pain is often considered a disease in itself and occurs when our nerves become hyperactive or “sensitized.” This can happen even if we have recovered from an injury to which we can trace our pain – or for no reason at all. Scientists were baffled by persistent pain, but now recognize that chronic pain is a disorder of the central nervous system. In some cases, pain signals simply emit impulses, driven by what researchers now believe to be a intricate set of genetic, endocrine and immunological processes.

One quarter of the world’s population suffers from chronic pain.

In the United States, approximately 100 million people suffer from chronic pain; worldwide it is as many as two billion. Despite these numbers and the financial, physical and emotional toll chronic pain takes, it has received only a fraction of the funding allocated to diseases like cancer and diabetes. There is also no national center for research on chronic pain. But researchers are finally beginning to understand the basic mechanisms of pain and how to treat it.

Some people are more likely to suffer from chronic pain than others.

Women are more likely to suffer from chronic pain than men. No one is quite sure why, but researchers point to two possible reasons: because women are more likely to suffer from autoimmune diseases and because their hormonal fluctuations can worsen the pain. However, we know that the development of chronic pain is not necessarily a result of the severity of the disease. Some people with relatively soft tissue damage experience terrible pain, while others with severe damage feel mostly fine. And when a person suffers from one type of chronic pain, they are more likely to develop another.

Scientists now believe that chronic pain such as cancer may have a number of genetic and cellular factors that vary depending on both the condition and the specific nature of the person experiencing it.

Modern research could revolutionize treatment.

One obstacle to developing an appropriate treatment for chronic pain is that there is no effortless way to “see” someone’s pain or measure it – a way to monitor the size of a tumor or assess how much the cerebral cortex has shrunk in someone with Alzheimer’s disease. Even now, doctors can only ask someone to rate their pain on a scale of 1 to 10.

Scientists and pharmaceutical companies studying pain have mostly used mice or other animals as human surrogates and then invested years or decades trying to develop a novel drug, only for it to prove ineffective in humans. Modern technologies have enabled scientists to recover and study tissue samples from patients suffering from chronic pain and determine what changes occur at the cellular level when pain becomes chronic. The goal is to design drugs that can specifically target these changes. Thanks to novel imaging technologies and computational capabilities, researchers can now quickly collect data on the microscopic changes affecting a particular patient’s condition: what can be called his or her pain signature.

All these advances could lead to personalized medicine that revolutionizes cancer treatment, or even a drug that could block pain signaling in most people, regardless of its cause.

In the meantime, there are specialized pain clinics.

Chronic pain patients are often stigmatized and even fired, in part because many doctors lack the necessary training to lend a hand them. However, there is a growing awareness of the complexity of pain and the need for treatment tailored to individual needs. Increasingly, patients are turning to pain clinics that offer this option: they can benefit from a multidisciplinary approach that includes physiotherapy, psychological counseling, and the care of specialized pharmacists and neurologists. This more time-consuming and careful approach can lend a hand identify all possible causes and the medication and other treatments that are most likely to enable patients to live better with their pain. While we don’t yet have the tools to reliably measure pain nerve dysfunction or changes in the brain’s pain circuitry, we may finally be getting closer to large-scale personalized pain treatment that will ultimately alleviate patient suffering.