Doctors working to find how to treat pain

The Wall Street Journal published, on Thursday, a special section on innovative ways to measure, understand and treat pain. Doctors hope to ease patients’ suffering without relying on potentially dangerous drugs.

In the lead story headlined, “A new prognosis for pain care,” Laura Landro wrote, “A new world of pain treatment is on the horizon.

“Advances in measuring pain could show doctors how much pain a patient feels more vividly and help them dial the treatment up or down more precisely. Better ability to assess each patient’s risk for chronic pain, including identifying genes that make it more likely, could lead to more personalized and effective treatments.

The story provides headlines on the different sectors being pursued for consequential improvement:

• How much does it hurt?

• Where does the pain come from?

• Using genetics to understand and treat pain.

• Going directly to the brain.

• A holistic approach to pain.

“The need has never been more urgent. More than 50 million adults in the U.S. are living with chronic pain at an estimated annual cost of $560 billion in medical care, lost productivity and disability programs, according to federal data,” the article reports.

Lower back pain and migraines are among the most common complaints, but chronic pain can affect any part of the body, drastically limit activity and lead to hopelessness and depression.

With few tools to understand what each patient is feeling, and why, doctors have often turned to a blunt, one-size-fits-all treatment: prescription opioids, which can be effective in treating acute pain after surgery or in the advanced stages of cancer.

But there is scant evidence that opioids are effective for chronic, long-term pain outside of end-of-life care and the sharp rise in opioid prescriptions after 1999, contributed to an epidemic of overdoses and deaths.

In 2016, the Centers for Disease Control and Prevention recommended against opioids as a first-line treatment of chronic pain.

Doctors have become more cautious, leading to a decline in prescribing rates.

For decades, doctors have used a simple 1 to 10 numerical scale and range of smiling to frowning faces, to assess how much pain a patient is feeling. Now researchers are developing objective measures for pain by monitoring how the brain reacts to it.

Researchers are developing assessments to provide a fuller picture of how pain affects a patient’s life. That has significant consequences for treatment.

“At the University of Washington Center for Pain Relief in Seattle, researchers developed an online assessment called PainTracker, where patients answer questions to determine what impact pain has on their lives.

Studies have shown that family history and shared genetic risk factors can play a role in the development of chronic pain.

To replace the need for drugs that can lead to addiction, researchers and device companies are also making advances in neuromodulation — the use of technology such as surgically implanted spinal cord stimulators to interrupt pain signals with electrical pulses to the brain.

Some pain medicine experts are returning to an idea originally conceived in the 1970s — combining modern technology with holistic approaches.

A growing body of evidence suggests approaches such as acupuncture, hypnosis, mindfulness meditation, spinal manipulation and yoga may help to manage chronic pain.

Last year, the National Institutes of Health doubled its budget for pain and addiction research to $1.1 billion.

Linda Porter, director of the Office for Pain Policy at the National Institute for Neurological Disorders and Stroke, part of the NIH, said, “We need to offer people with chronic pain something else, because they are desperate get better and get back to their lives.”

People in pain, whether periodic of chronic, will welcome any new solutions to this terrible curse that ruins the lives of so many.

The fact that there are numerous researchers working night and day on these most difficult problems should give some degree of hope to people in pain.  This is one of the most important efforts there is on Earth.

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