To overcome this problem, one of the major projects funded by HEAL focuses on studying the nervous systems of people with chronic pain more directly, in part by recovering malfunctioning dorsal root ganglia and trigeminal nerves from patients undergoing surgery for chronic pain, as well as from cadaver donors. . These samples are then cultured and examined using a range of new technologies – things like proteomics, spatial transcriptomics and metabolomics – to see how they differ from normal tissue. The goal, Gereau explained, is to identify what changes occur at the cellular level when pain becomes chronic and to create an atlas of those mechanisms and variations. Understanding this, he added, would eventually open the door to precision medicine, in which drugs could be designed to specifically target these changes, rather than simply dulling pain with anti-inflammatories or opioids.
“At first, everyone thought they were going to find this revolutionary pain medication that would replace opioids,” Gereau said. However, it seems increasingly clear that chronic pain, like cancer, may end up having a variety of genetic and cellular factors that vary both based on the condition and the particular makeup of the person experiencing it. “What we’re learning is that pain isn’t just one thing,” Gereau added. “It’s a thousand different things, all called ‘pain’.”
Even for patients The chronic pain landscape is extremely diverse. Some people endure a miserable year of low back pain, only to watch it fade away for no clear reason. Others are not so lucky. A friend of a friend spent five years with extreme pain in his arm and face after arguing with his son. He had to stop working, he couldn’t drive, he couldn’t even travel in a car without a neck brace. His doctors prescribed him endless medications: the maximum dose of gabapentin, plus duloxetine and others. At one point, he checked himself into a psychiatric ward because his pain was so bad that he was suicidal. There he met other people who also committed suicide after years of living with terrible pain day after day.
What makes chronic pain so terrible is that it is chronic: overwhelming anguish that never ends. For those suffering from extreme pain, it’s easy to understand. But even less severe cases can be miserable. A pain rating of 3 or 4 out of 10 seems mild, but having it almost all the time is exhausting and limiting. Unlike a broken arm, which gets better, or tendinitis, which hurts mostly in response to overuse, chronic pain makes your entire world shrink. It’s harder to work, exercise, and even do the many little things that make life rich and rewarding.
It’s also lonely. When my arms started going crazy, I could barely function. But even after the worst was over, I rarely saw friends; I still couldn’t drive for more than a few minutes, or sit comfortably in a chair, and I felt guilty inviting people over when there was nothing to do. As Christin Veasley, director and co-founder of the Chronic Pain Research Alliance, says: “With acute pain, medications, if you take them, get you over a hump and on your way. What people don’t understand is that when you suffer from chronic pain, even if you’re also taking medicine, you rarely feel the same as you used to. At best, they can reduce pain, but they usually don’t eliminate it.