As a child, there was only one time I ever saw my grandfather cry. It was during an attack of trigeminal neuralgia, an intense, agonizing pain in the face due to pressure on the trigeminal nerve, usually due to a blood vessel pushing on the nerve. The pain is sometimes described as worse than childbirth or passing a kidney stone. Fortunately, he was able to have a surgery which, in conjunction with medication, mostly suppresses the pain.
Many forms of chronic pain are not so easily cured. This January, I shadowed two physicians who specialize in physical medicine and anesthesiology. Most of their patients have some type of chronic pain—sometimes due to injury, sometimes due to arthritis or another medical condition, and sometimes due to an unknown cause. Some had histories of drug abuse to cope with the pain, or had been prescribed higher levels of medication by another doctor than was recommended by CDC guidelines. Neither of these methods worked particularly well, as the body can adjust to the amount of painkillers given. This increases the risk of opioid-induced hyperalgesia, in which patients on high doses of opioids actually feel more pain (Yi & Pryzbylkowski, 2015). Another poor coping mechanism some patients used was just ceasing as much activity as possible. Counterintuitively, some types of exercise, though painful, can actually be helpful in treating chronic pain, as exercise can reduce stress and releases endorphins (APA, n.d.).
Some of the patients I saw were using excellent coping mechanisms. One man had been severely injured in a mining accident and lived with chronic pain for years. His goal was to keep his pain as “background music” not a “rock concert.” Because this was a manageable goal and he was determined to care for himself, the doctor I was shadowing was more optimistic about his outcome. A positive mindset was a very helpful tool in living with chronic pain, and psychological factors play a large role in how we perceive pain. Having a realistic mindset and taking steps to manage pain can be very empowering. Consulting a pain specialist or another doctor (e.g. a neurologist in my grandfather’s case) is another way for individuals to explore ways to reduce their pain. Physical therapy can also be incredibly helpful, giving people back their function and decreasing pain.
Currently, the treatment for chronic pain is often opioids, surgical procedures such as spinal injections or ablation of nerves, and/or physical therapy. This may not always be the case, however. One suspected mechanism of chronic pain is nerve injury in dorsal root ganglion (DRG) neurons leading to a decrease in a specific type of potassium voltage-gated channel (Kv 1.2) (Guedon et al., 2015). Researchers found if RNA encoding for Kv 1.2 was introduced into the cell via a viral vector, Kv 1.2 numbers increased, and the pain response decreased. Researchers also found that introduction of the preproenkephalin gene in the amygdala reduced rats’ reactions to pain (Kang et al., 1998).
References
APA. (n.d.). Coping with chronic pain. https://www.apa.org/helpcenter/chronic-pain
Guedon, J. G., Wu, S., Zheng, X., Churchill, C. C., Glorioso, J. C., Liu, C., Liu, S., Vulchanova, L. Bekker, A., Tao, Y., Kinchington, P.R., Goins, W.F., Fairbanks, C. A., & Hao, S. (2015). Current gene therapy using viral vectors for chronic pain. Mol Pain 11:27. doi: 10.1186/s12990-015-0018-1
Kang W., Wilson, M.A., Bender, M.A., Glorioso, J.C., Wilson S.P. (1998). Herpe