The Biology of Pain: Understanding and Managing Chronic Pain

Nearly 50 million people in the United States and millions more around the world live with chronic pain. The causes are diverse, from cancer to diabetes to neurological illnesses and other ailments. But they share a common source of suffering: physical agony that disrupts their lives, intermittently or all the time. It’s not uncommon for cancer patients experiencing severe, unrelenting pain after chemotherapy to opt out of treatment in favour of the ultimate salve of dying.

The toll exacted by chronic pain has become increasingly visible in recent years. After doctors in the late 1990s began prescribing opioid medications such as oxycodone to alleviate persistent pain, hundreds of thousands of Americans developed an addiction to these drugs, which sometimes produce feelings of pleasure in addition to easing pain. Even after the risks became evident, the reliance on opioids continued, in part because there were few alternatives. No novel blockbuster painkillers have been developed in the past couple of decades.

• Misuse of opioids for pain relief

The misuse of opioid pain relievers—which are ideally suited for short-term management of acute pain—has become rampant across the United States. In 2017, an estimated 1.7 million Americans had a substance abuse disorder stemming from having been prescribed opioids, according to the National Survey on Drug Use and Health. Every day in the U.S., about 130 people die from opioid overdoses—a grim statistic that includes deaths from prescription painkillers as well as narcotics like heroin.

The quest to understand the biology of pain and find more effective ways to manage chronic pain has taken on fresh urgency. Researchers are making significant strides in detailing how pain signals are communicated from sensory nerves to the brain and how the brain perceives the sensation of pain. Scientists also are uncovering the roles that specific genes play in regulating pain, which is helping to explain why the perception and tolerance of pain vary so widely.

• Progress

These advances are radically altering how clinicians and scientists view pain—specifically chronic pain, defined as pain that lasts more than three months. Medical science traditionally regarded pain as a consequence of injury or disease, secondary to its root cause. In many patients, it turns out, pain originating from an injury or ailment persists long after the underlying cause has been resolved. Pain—in such cases—becomes the disease.

The hope is that this insight, coupled with the steadily advancing understanding of pain, will lead to new therapies for chronic pain, including nonaddictive alternatives to opioids. Norris and other patients are keen to see those breakthroughs happen. Researchers, meanwhile, are testing promising alternative strategies, such as stimulating the brain with mild electric shocks to alter its pain perception and harnessing the body’s intrinsic capacity to soothe its own pain.


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