Pain research and treatment are the topics of this week’s Newsweek cover story. The article centers on chronic pain caused by physical injuries in war, but it has gems for anyone with chronic pain. There’s a great illustration of how opioids and nerve blockers affect pain signals in the Pain and its Pathways graphic.
“‘The public understanding of pain has been that it’s a stubbed toe or a broken bone,’ says Will Rowe, executive director of the American Pain Foundation. ‘But that’s just one aspect of it. Now there’s a growing awareness that pain is a disease of its own.’
“This is far more than a semantic change, Rowe adds: it’s ‘tectonic.’ Docs now know that the brain and spinal cord rewire themselves in response to injuries, forming ‘pain pathways’ that can become pathologically overactive years later. They are trying to sever this maladaptive mind-body connection with a host of new drugs and approaches. Some focus on recently discovered chemical receptors in the brain and muscles. Others pack all the punch of narcotics with less of the specter of addiction. . . . New types of electrical stimulators targeting the brain, the spine and the muscles hit the market almost every year. Fentanyl skin patches, first introduced in 1990, have evolved into a patient-controlled, push-button device called IONSYS, available by the end of this year.”
Later in the article:
“Some of the most promising pain treatments of the past decade have turned out to be disappointments. Studies of some radiofrequency therapies show they work no better than placebos. Spinal-fusion surgery, a recent review found, has ‘no acceptable evidence’ to support it. And if a treatment does work, says Edward Covington, a pain specialist at the Cleveland Clinic, ‘for most people, the effect is temporary.’ There is no cure for chronic pain, period.
“There’s not even any ‘single drug or technology alone’ that can treat all the types of pain, says Eugene Viscusi, director of acute-pain management at Thomas Jefferson University Hospital in Philadelphia. Most people need two or three therapies in combination. Scientists’ new understanding of pain’s broad effects on many levels of the nervous system explains why: a multipart syndrome requires multipart therapy. Viscusi notes that patients under anesthesia still have elevated levels of the pain enzyme Cox-2 in their spinal fluid following surgery. They may not feel pain, but some parts of their brains still think they’re in it. For any treatment to work long term, it will have to address not just the immediate sensation of pain but the other, subtler aspects—and there are surely some of those that scientists don’t know about yet.”
I know a migraine can’t actually kill me, but there are days I’m sure I’m dying. I woke up in pain, but thought I’d aborted the migraine until I took a short walk. The cold air on my forehead caused searing pain. Rubbing the bridge of my nose, the classic headache pose, only intensified the pain.
I’m exhausted and spacey, pale with dark circles under my eyes, sweating and freezing, sensitive to touch and smells. Did I mention that I can barely think?
Running errands, I moved my car four blocks because I couldn’t stand the cold and didn’t have enough energy to walk the required eight blocks to and from my destination. Knowing making dinner would be impossible, I stopped at a new place with takeaway meals. The staff was excited to show me around and tell me what the place is all about, but I could barely comprehend what they were saying. I finally told them that I had a migraine and wasn’t up to talking. Something that I rarely, rarely do.
Now I’m home, both in place and spirit. Still, it’s going to be a long day.
In a recent study of more than 1,000 women with headache, those with chronic headache were four times more likely to report symptoms of major depression than women whose headaches are episodic. Chronic headache sufferers were also three times more likely to report other headache-related symptoms, such as low energy, trouble sleeping and dizziness.
I’m astonished by this finding: “The women with a diagnosis of severely disabling migraine had a 32-fold increased risk of major depression if they also reported other severe symptoms.” Thirty-two times. (If you fall into this category, as I do, consider putting someone on depression patrol — someone you see often and that you will listen to when they tell you that you seem depressed. It really helps.)
There’s a lot of debate over which comes first, pain or depression. There is no clear-cut answer, a topic that the study’s author broaches diplomatically: “Painful physical symptoms may provoke or be a manifestation of major depression in women with chronic headache, and depression may heighten pain perception.” Well put.
The American Academy of Pain Medicine‘s 22nd annual meeting begins tomorrow. Topics include FDA regulation of pain treatments, advocacy issues and alternative therapies for treating pain.
Could be good stuff. I’ll let you know what comes out of it.
In the US, about 50 million people have some form of chronic pain, yet there is little known about how and why we feel pain. (Although the revelation that chronic pain may be caused by healthy nerves, not damaged ones as previously though, may change that.)
FOX News examines chronic pain in The Pain Truth: How and Why We Hurt. From describing how little is known about pain to the complexity of it to ways to treat it, the article teaches the basics of pain.
According to FOX, researchers at the Mayo Clinic say “chronic pain, which might result from inflammation, can be amplified and distorted like music turned up beyond a speaker’s capability, causing pain out of proportion to the source.”