Monday, February 20, 2012

Chronic Pain and the Development of Pain Relieving Medications
It takes a village only after Research appreciates the villagers.
Published on July 29, 2011 by Dr. Mark Borigini in Overcoming Pain

Chronic pain remains an unsolved public health problem. Millions of Americans live with chronic pain, impacting many aspects of the lives of the sufferers-and those who interact with the sufferers, whether they be family, friends, or employers. In fact, chronic pain has a greater impact on the United States economy in terms of health insurance, lost wages and reduced productivity than virtually any other chronic health condition, including diabetes, hypertension, and heart disease.
There are several methodological issues that hinder the development of novel pain-relieving medications. For example, over the last couple of hundred years, most pain research has focused on more transient pain models that do not result in tissue damage, and thus do not reflect what is occurring in a chronic pain patient. On the other hand, studies focusing solely on patients suffering from chronic pain may miss time points when an intervention aimed at preventing chronic pain is most effective. Are there missed opportunities whereby central sensitization can be interrupted, effectively halting the metamorphosis of acute injury to chronic pain?
Scientists have sequenced the human genome, cloned all sorts of organisms, and developed a variety of biological agents to treat heretofore difficult to treat conditions. However, there have been few new drugs to treat pain over the last couple of decades.
Therefore, many researchers are beginning to call for a shift in the strategies utilized in the development of pain medications. It is important to understand the changes in the nervous system that result in the pain experience, and this encompasses the appreciation that acute and chronic pain are different entities. Researchers must measure many signs and symptoms when studying pain, not just whether a patient states their pain is a "2" or a "10".
The principles of pharmacogenomics may assist researchers in their quest for targeted pain relief. It might be possible to uncover a causal relationship between genetic make-up and the response to medications.
It follows that the appropriate measures of patient response are crucial in establishing a pattern of response, or lack therof. A focus on the individual can thus lead to the identification of cohorts of pain sufferers whose genetic pain mechanism "fits" a particular pharmacologic intervention.
Answers to the conundrum of chronic pain, its relation to acute pain, and the genetic and psychological composition of the individual, are going to be found in the individual. This will go a long way to helping the general population of chronic pain patients.
It takes a village only after Research appreciates the villagers.