Chronic pain science has come a long way in the last few decades. There are new treatments, newly-recognized disorders and syndromes, and newly-identified correlations, but the medical community has yet to puzzle out all the intricacies of chronic pain science. Pain can occur for no apparent reason and resist all attempts at treatment, so it’s clear that scientists still have a lot to learn about chronic pain.
Advances are made in chronic pain science all the time. Individually, each of these seven advances in chronic pain science may seem small or insignificant. Together, though, these advances represent a few more steps toward understanding everything there is to know about chronic pain science.
Oftentimes, it’s unclear why someone experiences widespread chronic pain. Researchers at the University of Southampton, though, may be closing in on one of the reasons behind widespread chronic pain. They found that individuals who had reported a fracture or broken bone in the past were much more likely to experience chronic widespread pain later in life. If more research can shed light on the association between fractured or broken bones and chronic pain, it might eventually be possible to find a way to utilize this association to reduce the likelihood of chronic pain.
Preventing falls is one of the best ways to prevent chronic pain, especially since recent chronic pain science seems to suggest a connection between chronic pain and past fractures. For the elderly, preventing falls is even more vital to overall health; even reducing the fear of falling in the elderly can encourage more activity and improve health.
Researchers at the Wake Forest Baptist Medical Center recruited homebound elderly participants through the Meals-on-Wheels program. Half the participants were given a placebo with their meals, while the others were given a large dose of vitamin D. At the beginning of the study, half of the participants had insufficient amounts of vitamin D. By the end of the study, though, all but one of the study participants who had received vitamin D achieved sufficient amounts of vitamin D. Additionally, people in the vitamin D group reported half as many falls after the study. This suggests that something as simple as taking vitamin D supplements to maintain sufficient amounts of the vitamin might reduce the risk of falls.
Spinal cord stimulation (SCS) is a pain therapy that involves electrodes implanted near the spine. An electrical impulse is delivered by the electrodes, interrupting pain signals and providing relief from pain (usually limb or spinal pain). The electrical impulse is typically at a low frequency, around 40 to 60 hertz. By using a higher frequency, around 10,000 hertz, significantly more pain relief was delivered. More than 80% of those utilizing high frequency SCS experienced pain relief, compared to around half of those utilizing traditional SCS.
In addition to the improved pain relief, using high frequency SCS eliminated the side effect of paresthesia. Paresthesia is a tingling, pins-and-needles sensation that masks pain sensations. It’s common with therapies that utilize electrical stimulation, and it often becomes uncomfortable or distracting. If utilizing high frequency SCS could provide more effective pain relief, without paresthesia, it could soon become a replacement for traditionally low frequency SCS.
This was studied in particular in individuals with health complications that impact nerve function. Several different chronic pain conditions involve the nerves. Stroke victims, too, can experience lessened sensory performance, but stroke victims have benefitted from the use of special high frequency electrical stimulation gloves. Because of this, one group of researchers tested the use of these same gloves with people who have complex regional pain syndrome (CRPS), a chronic pain condition that’s believed to be related to malfunctioning nerves.
During initial testing, the trial participants experienced significant tactile sensory performance improvement. Although there was no overall pain relief, individual participants reported pain relief of at least 30%.
We already know that chronic pain can cause changes to the brain, but a pair of drugs – when used together at just the right time – show promise when it comes to reversing these changes in the brain. L-dopa, a drug normally used to treat Parkinson’s, and a non-steroidal anti-inflammatory drug (NSAID) successfully reversed chronic pain-related changes in rats’ brains, if the medications were given shortly after an injury. The drug combo even eliminated the rats’ chronic pain behavior.
The next step will be human trials. Utilizing this drug combination to treat people’s chronic pain may be quite a ways off, but if the human trials go as well as the animal trials have, there may be a very promising new type of treatment eventually.
Sometimes chronic pain science can impact other facets of medical science. That’s the case with diclofenac, an NSAID commonly used for pain from conditions like arthritis or menstrual cramps. The ReDO project, which stands for Repurposing Drugs in Oncology, reconsiders economically-priced, easily-available medications as potential cancer treatments. Diclofenac is one of the drugs being considered. Types of cancers that diclofenac could potentially help treat include:
There are currently four different trials being carried out to assess diclofenac’s effectiveness as part of a cancer treatment.
7. There’s more evidence that opioids shouldn’t be the first line of defense against pain
We’ve known for some time that depression and pain are closely related to each other. If one worsens, the other probably will, too. Treating one might help the other. Now, though, researchers might have figured out a bit more about what not to do. A study found that treating neck or back pain with opioids, while neglecting to treat co-occuring depression or anxiety, will provide little pain relief. Instead, evidence suggests that it’s better to treat depression or anxiety first or at the same time, as well as to try treating neck or back pain with non-opioid painkillers first.
It’s also becoming increasingly clear that, if at all possible, it’s best to avoid opioid use while pregnant. As the use of prescription opioids during pregnancy has increased over the last few years, so too has the rate of neonatal abstinence syndrome (NAS) increased. NAS is a group of symptoms and health problems, often similar to withdrawal, that occur in a newborn whose mother used opiates during pregnancy. The incidence of NAS more than doubled between 2000 and 2009. It’s suggested that if possible, opioids should be avoided during pregnancy. If pain is unmanageable without opioids, use should be limited as much as possible, and the mother should stay in close contact with her physician throughout her pregnancy.
Have you heard about any interesting chronic pain science advances?