To address this, a major HEAL-funded project is focused on studying the nervous systems of people with chronic pain, in part by restoring dysfunctional dorsal root ganglia and trigeminal nerves from patients undergoing surgery for chronic pain. pain, as well as from cadaveric 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 these 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 the pain with anti-inflammatories or opioids.
“At first, everyone thought they were going to find this breakthrough pain medication that would replace opioids,” Gereau said. Increasingly, however, it appears that chronic pain, like cancer, could end up having an array of genetic and cellular factors that differ both by the condition and the specific makeup of the individual experiencing it. “What we’re learning is that pain is not just one thing,” Gereau added. “It’s a thousand different things, all called ‘pain’.”
And for patients, the landscape of chronic pain varies enormously. Some people endure a miserable year of lower back pain, only to have it go away for no apparent reason. Others are not so lucky. A friend of a friend spent five years with severe pain in his arm and face after roughing up his son. He had to stop working, he couldn’t drive, he couldn’t even drive in a car without a neck brace. His doctors prescribed endless drugs: the maximum dose of gabapentin, plus duloxetine and others. At one point, he was admitted to a psychiatric ward because his pain was so great that he was suicidal. There, he met other people who also became suicidal after years of living in excruciating pain day after day.
What makes chronic pain so awful is that it’s chronic: an affliction that never ends. For those with excessive pain, this is easy to understand. But even less severe cases can be miserable. A pain rating of 3 or 4 out of 10 sounds mild, but having it almost all the time is exhausting – and limiting. Unlike a broken arm, which heals, or tendonitis, which hurts mostly in response to overuse, chronic pain makes your whole world shrink. It’s harder to work, exercise, and even do many of the smaller things that make life rewarding and rich.
It’s also lonely. When my hands first went crazy I could barely function. But even after the worst was over, I rarely saw friends. I still couldn’t drive more than a few minutes or sit comfortably in a chair and 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, the drugs, if you take them, get over you and you’re on your way. What people don’t realize is that when you have chronic pain, even if you also take medication, you rarely feel the same as before. At best, they can reduce your pain, but they usually don’t eliminate it.”
