Most of us don’t think about pain until we feel it. And when we do, it’s typically something we get over after a few days or weeks. This was my experience, until the summer of 2023. One day I woke up and found that my arms hurt. There was no obvious explanation, I hadn’t done anything. The pain was intense. I couldn’t do much: drive, cook, type, even sleep. I have always been a healthy person who played a lot of sport and I thought 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 there was an epidemic of chronic pain going on all around me.
As my condition persisted, I began looking into what scientists understand — 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 are now on the verge of a revolution, one that is already transforming the way 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 In suffer but not die From It. Chronic pain is now often considered a disease in its own right, occurring when our nerves become overactivated or “sensitized.” This can happen even if we have healed from the wound to which we can trace our pain, or for no reason at all. Scientists were mystified by persistent pain, but now recognize that chronic pain is a disorder of the central nervous system. In some cases, pain signals continue to fire, driven by what researchers now think is a complex set of genetic, endocrinological and immunological processes.
A quarter of the world’s population suffers from chronic pain.
In the United States, approximately 100 million people suffer from chronic pain; globally, there are 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 receive. And there is no national center for the study of chronic pain. But researchers are finally starting to understand the mechanisms behind pain and how to treat it.
Some people are more likely to suffer from 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 greater risk of autoimmune diseases and because their hormonal fluctuations can make the pain worse. What we know is that the development of chronic pain is not necessarily a product of the severity of the disease. Some people with relatively mild tissue damage experience terrible pain, while others with severe damage feel mostly fine. And once a person has one type of chronic pain, they are more likely to develop another.
Researchers now believe that chronic pain, like cancer, may end up having a number of genetic and cellular factors that vary both based on the condition and the particular makeup of the person experiencing it.
New research could revolutionize treatment.
One obstacle to developing an adequate treatment for chronic pain has been the fact that there is no easy way to “see” someone’s pain or measure it, in the same way you can monitor the size of a tumor or assess how much the cerebral cortex of someone with Alzheimer’s is reduced. . Even now, all doctors can do is ask someone to rate their pain on a scale of 1 to 10.
Researchers and pharmaceutical companies studying pain mostly used mice or other animals as human proxies and then invested years or decades trying to develop a new drug only to see it fail in humans. New technologies have allowed researchers to recover and study tissue samples taken from patients with chronic pain and to understand what changes occur at the cellular level when pain becomes chronic. The goal is to design drugs that can specifically target such changes. And thanks to new imaging technologies and computing capabilities, researchers can now quickly collect data on the microscopic changes that shape an individual patient’s condition — what might be called the pain signature.
All of these advances could lead to the kind of personalized medicine that has revolutionized cancer treatment, and even a drug that can block pain signaling for most people, regardless of its cause.
Meanwhile, there are clinics specializing in pain.
Patients with chronic pain are often stigmatized and even fired, in part because many doctors lack the training to help them. But there is a growing awareness of the complexity of pain and the need for tailored management. Patients are increasingly turning to pain clinics that offer this possibility: there they can benefit from a multidisciplinary approach that includes physical therapy, psychological counseling, specialized pharmacists and neurologists. This more careful and time-consuming approach can help identify all possible causes, as well as the medications and other therapies most likely to allow patients to live better with their pain. While we don’t yet have the tools to reliably measure the dysfunction of our pain nerves or changes in the pain circuitry in the brain, we may finally be getting closer to large-scale personalized pain treatment that will finally alleviate patient suffering.