To overcome this problem, a major HEAL-funded project is focused on studying the nervous system of chronic pain patients more directly, in part by recovering dysfunctional dorsal root ganglia and trigeminal nerves from patients undergoing surgery for chronic pain, as well as from cadaveric donors . These samples are then cultured and examined using a range of new technologies, such as proteomics, spatial transcriptomics and metabolomics, to understand how they differ from normal tissue. The goal is to determine what changes occur at the cellular level when pain becomes chronic and create a map of these mechanisms and changes, Gereau explained. Understanding this, he adds, could ultimately open the door to precision medicine, where drugs could be designed to specifically target these changes, rather than simply reducing pain with anti-inflammatory drugs or opioids.
“In the beginning, everyone thought they were going to find a breakthrough painkiller to replace opioids,” Jero said. Still, there is growing consensus that chronic pain, like cancer, may ultimately have a range of genetic and cellular drivers that vary depending on the condition and the specific makeup of the person experiencing the pain. “We learned that pain is not just one thing,” Jero added. “There are a thousand different things, all called ‘pain.'”
The same goes for patients, Chronic pain conditions come in many forms. Some people live with painful lower back pain for a year, only to have it disappear for no apparent reason. Others are not so lucky. A friend of a friend suffered from excruciating pain in his arms and face for five years after a fight with his son. He had to stop working and couldn’t drive, not even without a neck brace. His doctor prescribed him numerous medications: maximum dose gabapentin, plus duloxetine, among others. At one point, he was admitted to a psychiatric ward because his pain was so severe that he became suicidal. There he met others who were also suicidal after enduring horrific pain day after day.
What makes chronic pain so scary is that it’s chronic: a never-ending ordeal of pain. For those in extreme pain, this is easy to understand. But even less serious situations can be tragic. A pain rating of 3 or 4 out of 10 sounds mild, but living with it almost constantly is exhausting and limiting. Unlike a broken arm (which gets better) or tendonitis (pain caused primarily by overuse), chronic pain can make your entire world shrink. It becomes more difficult to work, exercise, and even do the many little things that make life meaningful and enriching.
It’s also lonely. When my arms first went crazy, I could barely move them. But even after the worst was over, I rarely saw my friends. I still can’t drive for more than a few minutes or sit comfortably in a chair, and I feel guilty inviting people over when I have nothing to do. As Christin Veasley, director and co-founder of the Chronic Pain Research Alliance, said: “With acute pain, if you take medications, they help you get through it and move on. People don’t realize The thing is, when you have chronic pain, you rarely feel the same as before, even if you take medications. At best, they can reduce your pain, but usually don’t eliminate it.
