Most of us don’t think about pain until we have it. And when we do, it’s usually 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 hands hurt. There was no obvious explanation, nothing I had done. The pain was intense. I couldn’t do many things: drive, cook, type, even sleep. I have always been a healthy person who did a lot of sports and thought this strange pain was just bad luck. But as the weeks turned into months and there was no cause or cure, I began to realize that I wasn’t alone: ​​that there was an ongoing epidemic of chronic pain all around me.
As my condition persisted, I began looking into what scientists understood—and still don’t understand—about chronic pain. I was mostly shocked to learn how little we know about its causes. But I also discovered that we are now on the cusp of a revolution, one that is already changing the way we think about — and deal with — chronic pain. (Read the full Times Magazine article.)
Chronic pain is not just a symptom, but a disease.
We used to think we might die in hurt but don’t die of the. Now chronic pain is often considered a disease in itself, one that occurs when our nerves become over-activated or “sensitized.” This can happen even if we have healed from the injury to which we can trace our pain—or for no reason at all. Scientists used to be concerned about persistent pain, but now they recognize that chronic pain is a disorder of the central nervous system. In some cases, pain signals continue to be emitted, driven by what researchers now believe to be 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 have chronic pain. worldwide, it amounts to two billion. Despite these numbers and the financial, physical and emotional toll chronic pain takes, it has received only a fraction of the funding that diseases like cancer and diabetes have. And there is no national center for the study of chronic pain. But researchers are finally beginning to understand the underlying mechanisms of 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 quite sure why, but researchers point to two possible reasons: because women are at greater risk for autoimmune disorders, and because their hormonal fluctuations can make the pain worse. What we do know is that developing chronic pain is not necessarily a product of the severity of your illness. Some people with relatively mild tissue damage experience excruciating 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, could end up having a number of genetic and cellular factors that vary by both the condition and the specific makeup of the person experiencing it.
New research could revolutionize treatment.
One obstacle to developing appropriate treatment for chronic pain has been that there is no easy way to “see” someone’s pain or measure it — the way you can track the size of a tumor or measure how much the cerebral cortex has shrunk of someone with Alzheimer’s. Even now, all doctors can do is ask someone to rate their pain on a scale of 1 to 10.
Researchers and drug companies studying pain have mostly used mice or other animals as proxies for humans and then invested years or decades trying to develop a new drug only to have it fail in humans. New technologies have allowed researchers to retrieve and study tissue samples taken from patients with chronic pain and understand what changes occur at the cellular level when pain becomes chronic. The goal is to design drugs that can specifically target these changes. And thanks to new imaging technologies and computing capabilities, researchers can now quickly collect data on the tiny changes that drive an individual patient’s condition: what might be called their pain signature.
All of these developments could lead to the kind of personalized medicine that has revolutionized cancer treatment, and even a drug that could block pain signaling for most people, regardless of its cause.
In the meantime, there are specialist pain clinics.
Chronic pain patients are often stigmatized and even dismissed, in part because many doctors lack the necessary training to help them. But there is growing awareness of the complexity of pain and the need for individualized management. Increasingly, patients are 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 time-consuming and careful approach can help identify all possible causes and the medication and other treatments that are most likely to enable patients to live better with their pain. While we don’t yet have the tools to reliably measure dysfunction in our pain nerves or changes in the brain’s pain circuitry, we may finally be getting closer to the large-scale personalized pain therapy that will finally relieve patients’ pain.
