Most of us don’t think about pain until we have it. And when we do, it’s usually something we get over after a few days or weeks. This was my own experience, until the summer of 2023. One day I woke up and found that my arms hurt. There was no clear explanation, I had done nothing. The pain was intense. I couldn’t do much: drive, cook, type, even sleep. I had always been a healthy person who played a lot of sports, and I thought this strange pain was just bad luck. But as the weeks turned into months, and no cause or cure could be found, I began to realize that I wasn’t alone: that there was an ongoing epidemic of chronic pain all around me.
As my condition persisted, I began to see what scientists did — and still don’t — understand about chronic pain. Mostly I was surprised to learn how little we know about its causes. But I also discovered that we’re on the brink of a revolution, one that’s already changing how we think about — and treat — chronic pain. (Read the full magazine article.)
Chronic pain is not just a symptom but a disease.
We thought we might die. i There is pain but not death Of This chronic pain is now often considered a disease in its own right, which occurs when our nerves become over-stimulated or “sensitized”. This can happen even if we’ve recovered from the injury enough to detect our pain—or for no reason at all. Scientists used to be mystified by chronic pain but now recognize that chronic pain is a disorder of the central nervous system. In some cases, pain signals just keep firing, which researchers now believe is a complex combination of genetic, endocrinological and immunologic processes.
A quarter of the world’s population suffers from chronic pain.
Some 100 million people in the United States have chronic pain; Globally, it’s up to two billion. Despite these numbers, and the financial, physical and emotional toll that chronic pain takes, it has received only a fraction of the funding for diseases such as cancer and diabetes. And there is no national center for the study of chronic pain. But researchers are finally beginning to understand the underlying mechanisms of pain — and how to treat it.
Some people are more prone to chronic pain than others.
Women are more likely to develop chronic pain than men. No one is entirely sure why this is, but researchers point to two possible reasons: because women are more prone to autoimmune disorders, and because their hormonal fluctuations May increase pain. What we do know is that an increase in chronic pain is not necessarily a result of the severity of your illness. Some people with relatively mild tissue damage experience excruciating pain, while some people with severe damage feel mostly fine. And once a person has one type of chronic pain, they are more likely to have another.
Researchers now believe that chronic pain, like cancer, has a range of genetic and cellular drivers that vary depending on the condition and the specific makeup of the person experiencing it.
New research could revolutionize treatment.
One obstacle to developing an adequate treatment for chronic pain is that there is no easy way to “see” or measure one’s pain—the way you might monitor or estimate the size of a tumor. How much the cerebral cortex of someone with Alzheimer’s has shrunk. . Still, all doctors can do is ask someone to rate their pain on a scale of 1 to 10.
Pain researchers and pharmaceutical companies primarily use mice or other animals as human proxies and then spend years or decades trying to develop a new drug only to have it fail in humans. New technologies have enabled researchers to retrieve and study tissue samples taken from chronic pain patients and learn what changes occur at the cellular level when pain becomes chronic. The goal is to design drugs that can specifically target these changes. And thanks to new imaging technologies and computing capabilities, researchers can now increasingly gather data on the microscopic changes that drive an individual patient’s condition: what might be called their pain signature.
All of these advances could lead to the kind of personalized medicine that has revolutionized cancer treatment and even to drugs that can block pain signals for most people, regardless of the cause. Be that as it may.
Meanwhile, there are specialized pain clinics.
Chronic pain patients are often stigmatized, and even dismissed, because many doctors lack the training necessary to help them. But awareness of the complexity of pain and the need for appropriate management is increasing. Increasingly, patients are turning to pain clinics that offer this possibility: there, they can benefit from a multidisciplinary approach that includes physical therapy, psychological counseling, specialty pharmacists and neurologists. This more timely and attentive approach can help identify all possible causes and is more likely to enable patients to live better lives with their pain than medications and other treatments. Although we don’t yet have the tools to reliably measure dysfunction in our pain nerves or changes in the brain’s pain circuitry, we are finally getting closer to mass-personalized pain treatment. which will eventually reduce the patient’s suffering.