Chronic Pain: Five Things We Know About Causes, Treatments and Diagnoses
Most of us don’t think about pain until we have it. And when we do, it’s typically something we get over after a few days or weeks. That was my own experience, until the summer of 2023. One day I woke to find that my arms hurt. There was no obvious explanation, nothing I’d done. The pain was intense. I couldn’t do much of anything: drive, cook, type, even sleep. I’d always been a healthy person who did a lot of sports, and I figured 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 wasn’t alone: that all around me was an ongoing epidemic of chronic pain.
As my condition persisted, I started looking into what scientists do — and still don’t — understand about chronic pain. Mostly I was shocked to learn how little we know about its causes. But I also discovered that we’re now on the cusp of a revolution, one that is already transforming how we think about — and treat — chronic pain. (Read the full magazine article.)
Chronic pain is not just a symptom, but a disease.
We used to think that we may die in pain but don’t die of it. Now chronic pain is often considered an illness in its own right, one that occurs when our nerves become hyperactivated or “sensitized.” This can happen even if we have healed from the injury to which we can trace our pain — or for no reason at all. Scientists used to be mystified by persistent pain but now recognize that chronic pain is a disorder of the central nervous system. In some cases, pain signals just keep firing, driven by what researchers now think is a complex set of genetic, endocrinological and immunologic processes.
A quarter of the world’s population suffers from chronic pain.
In the United States some 100 million people have chronic pain; globally, it’s as many as 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 that diseases like cancer and diabetes have. 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 likely to suffer chronic pain than others.
Women are more likely to develop chronic pain than men. No one is entirely sure why, but researchers point to two possible reasons: because women are at higher risk for autoimmune disorders, and because their hormonal fluctuations can aggravate pain. What we do know is that developing chronic pain isn’t necessarily a product of the severity of your illness. Some people with relatively mild tissue damage experience terrible pain, while others with severe damage feel mostly fine. And once a person has one kind of chronic pain, they’re more likely to develop another.
Researchers now believe that chronic pain, like cancer, could end up having a range of genetic and cellular drivers that vary both by condition and by the particular makeup of the person experiencing it.
New research could revolutionize treatment.
One hurdle to developing adequate treatment for chronic pain has been that there’s no easy way to “see” someone’s pain or to measure it — the way you can monitor the size of a tumor or gauge how much the cerebral cortex of someone with Alzheimer’s has shrunk. Even now, all doctors can do is ask someone to rate their pain on a scale from 1 to 10.
Researchers and pharmaceutical companies studying pain primarily used mice or other animals as human proxies and would then invest years or decades trying to develop a new drug only to have it fail in humans. New technologies have enabled researchers to recover and study tissue samples taken from patients with chronic pain and to figure out what changes happen at a cellular level when pain becomes chronic. The goal is to design drugs that can target those changes specifically. And thanks to new imaging technologies and computing abilities, researchers can now rapidly gather data on the microscopic changes driving 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 a drug that could block pain signaling for most people, regardless of its cause.
In the meantime, there are specialized pain clinics.
Patients with chronic pain are often stigmatized, and even dismissed, in part because many doctors lack the necessary training to help them. But there is growing awareness of the complexity of pain and the need for tailored management. Increasingly, patients are turning to pain clinics that offer that possibility: There, they can benefit from a multidisciplinary approach that includes physical therapy, psychological counseling, specialized pharmacists and neurologists. This more time-intensive and closely attentive approach can help identify all possible causes and the drug and other therapies most likely to enable patients to better live with their pain. Though we don’t yet have the tools to reliably measure dysfunction in our pain nerves or changes in the brain’s pain circuit, we may at last be getting close to the large-scale personalized treatment of pain that will finally alleviate patient suffering.
