Recent treatments offer much-needed hope for patients with chronic pain

Hundreds of thousands and thousands People everywhere in the world suffer from chronic pain – this implies persistent pain longer than three months. Although the figures vary from country to country, most studies assume that about 10% of the world population This affects greater than 800 million people.

The Centers for Disease Control and Prevention estimate that in 2021, about 20% of adults within the United States – or greater than 50 million people – have chronic painOf these, about 7% experienced what’s severe chronic painPain that significantly limits an individual’s each day activities.

In the past, doctors were quick to prescribe medication as a straightforward solution. But the Opioid crisis within the USA has caused doctors to rethink their reliance on medications and look for brand spanking new treatments for patients with chronic pain.

The Conversation spoke to Rachael Rzasa LynnA Specialist in pain therapy from the University of Colorado Anschutz Medical Campus for our podcast The Conversation Weekly. She explains a few of the latest developments in pain management and why there may be hope for patients with chronic pain.

What is the fundamental reason behind chronic pain?

In general, pain is a fancy interplay between tissue injury or inflammation, nerves and brain processes.

There are several biological processes that may cause pain. The process that happens in most individuals after they experience acute pain is named nociceptive pain. This pain occurs when tissue is injured or damaged not directly, triggering the activation of surrounding nerves. These nerves are like electrical wires that send signals from the injured tissue through the spinal cord to the brain, where the pain is ultimately perceived.

But the activation of those nerves alone doesn’t mean that pain occurs, because these electrical signals are amplified or weakened at several points on their technique to the brain. The brain's perception of pain is crucial, because pain doesn’t occur when persons are unconscious.

Nociceptive pain can be brought on by persistent tissue injury or inflammation, as within the Case of arthritisIn these injuries, the peripheral nerves chronically transmit signals to the brain, leading to persistent pain perception.

There are other disease processes, similar to diabetic peripheral neuropathywhere the nerves themselves are injured. In these cases, the nerves send pain signals to the brain that reflect an injury to the nerves themselves, to not the tissue from which they originate. This is named Neuropathic pain.

In other types of chronic pain, the so-called nociplastic painThe initial tissue injury can completely heal, however the brain and nervous system proceed to generate pain signals.

In fact, many chronic pain conditions involve a mixture of all three phenomena – nociceptive, neuropathic and nociplastic pain – which further complicates diagnosis and treatment.

How do doctors such as you measure pain?

I feel anyone who has been in a hospital within the last decade, not less than within the United States, is acquainted with the numerical scale on which they must rate their pain. It's a one-dimensional pain assessment that just asks how much pain you might have.

But pain is a really complex phenomenon, with many more features than simply the severity of the pain. So a single numerical value based on the severity of the pain ignores the impact that pain can have on a patient's each day life, similar to their activities, their relationships, their ability to sleep, their happiness and their overall satisfaction with their life.

I feel the toughest thing about all pain, but especially many types of chronic pain, is you can't see it. There isn’t any external, validated technique to really understand how much pain someone is in. While we’ve got newer ways of measuring pain that attempt to capture a few of these more complex features, it's still a really incomplete science. It's still all subjective and based on what the patient tells you about their experience.

Which latest pain treatment options are most promising?

A brand new popular treatment is named Pain reprocessing therapywhich takes a behavioral approach to pain relief.

Here at our medical campus, therapists help patients understand the causes of chronic pain after which reappraise the sensations they perceive as painful – similar to typically painful movements. The goal of pain processing therapy is to assist patients perceive the pain signals sent to their brain as less threatening, so their brain “unlearns” the pain.

Another approach that’s being applied in a brand new way is Nerve ablationa procedure during which the nerves around a painful area are numbed with drugs after which intentionally damaged. In these cases, doctors inject a chemical across the nerves or gently heat them in order that they’ll now not send pain signals for months and even years. This approach has been used for a long time for back pain, but is now getting used for pain in other areas of the body as well.

An identical approach is to stimulate the nerves that offer a painful area with electricity to vary or block the best way pain signals travel through them. In this method, a tiny electrical device is placed next to the nerve to transmit the low level of current. This is an example of Neuromodulationwhich is increasingly getting used to treat a wide range of chronic pain conditions throughout the body, from foot pain to migraines. It has even shown promise in treating acute pain following surgeries similar to knee replacements.

A classic example of neuromodulation is spinal cord stimulation, which is used to treat a variety of chronic pain conditions. It involves a surgeon placing wires beneath the bones of the back, but outside the spinal cord and spinal fluid. The wires are connected to a battery that, much like a pacemaker battery, sends electrical signals to the nerves within the spinal cord to decode the pain signals.

What role has the opioid crisis played?

These latest treatment options for patients with chronic pain may not have developed so quickly if it weren’t for the Opioid crisis.

For a long time, Opioids have been overprescribed for chronic pain. However, there are some patients with chronic pain for whom opioids really do profit when it comes to pain relief and quality of life. In my view, doctors have overcorrected somewhat, so it might now be difficult for these patients to access the opioid therapies that worked so well for them. Due partly to a slowdown in opioid production lately, many patients in some parts of the United States now not have access to those medications in any respect.

Therefore, researchers are actually working to develop latest drugs to alleviate pain without the addiction and overdose risks related to opioids. CannabinoidsIn recent years, the main target of patient care has shifted from drug treatment to behavioral and procedural interventions, including neuromodulation.

Looking to the long run: What’s next?

I feel the holy grail of pain medicine is to search out out which patients with the identical disease will reply to the identical treatment. For example, two patients with a degenerative tissue disease like arthrosis of the knee can have almost an identical x-rays, yet the perception of pain and response to treatment may be completely different. One patient may profit from physical therapy, while one other may not improve with physical therapy alone and will require multiple medications, injections, and eventually surgery – and should still must live with pain.

Researchers like me don't yet know what characteristics make one patient different from one other when it comes to these outcomes. This signifies that current treatment plans involve plenty of trial and error, which may be tedious and frustrating for patients in pain.

My goal and best hope for the long run of pain medicine is that researchers will find a greater technique to predict who will reply to a selected treatment so that they can match each patient with the appropriate treatment regimen the primary time.