15 ms·

Will there ever be a cure for chronic pain?

83 points by prostoalex 7y ago

juancn 7y ago
Should there be one? Pain is a symptom of something else, treat the root cause. Managing pain should only be a temporary measure.
- theobon 7y ago
  This is well understood by pain researchers and the article explicitly mentions that they are trying to find solutions that address chronic pain without impacting the pain responses you are referring to. "The team bred genetically engineered mice from embryos that had HCN2 excised from their DNA. Subsequent experiments showed that these mice did not develop neuropathic pain (the kind that affects the nervous system and is often caused by long-term conditions such as cancer or diabetes). Not only that, the mice with HCN2 cut out were still able to feel acute pain – the necessary, protective jolt that tells us to remove our finger from a drawing pin. “That’s the holy grail,” McNaughton told me"
- _eht 7y ago
  This is a limited scope viewpoint.
- viklove 7y ago
  You've clearly never had a surgery. Many invasive surgeries can result in lifelong pain with no underlying cause. Having a doctor muck about with your internals leaves nerve endings in the wrong place and scar tissue that will never heal. Source: Had two pneumothoraces that resulted in lung surgery years ago, still get pain every day that I just have to ignore.
  - ed312 7y ago
    While the parent is being a bit crass, there is a valuable underlying point. Ignoring pain is akin to ignoring the "check engine light". We (as a society) should really try to figure out the root causes AND (not or) find more targeted pain management. Perhaps your pain can be safely ignored (from a medical point of view). Perhaps its truly a signal there is a new or greater risk.
    - viklove 7y ago
      Well as you can imagine, chest pain is rather worrying. I've been to the ER and seen various doctors (and had a lot of xrays and CT scans done). They haven't found anything, and told me it's to be expected with the surgeries I've been through. Humans aren't engineered like vehicles. Sometimes you just have a faulty "check engine light" and there's nothing you can do about it.
    - johnfactorial 7y ago
      Pain was once considered a fact of life, and vital signs were those 4 signs which can indicate a patient is alive: body temp, pulse, respiratory rate, and blood pressure. Then the notion of pain as the "fifth vital sign," came about. Some argue we resultantly now have an opioid epidemic. There is a fascinating NPR show episode on this topic: https://www.npr.org/programs/invisibilia/701219878/the-fifth-vital-sign https://www.npr.org/programs/invisibilia/701219878/the-fifth.... Edit: another source of info: https://www.medpagetoday.com/publichealthpolicy/publichealth/57336 https://www.medpagetoday.com/publichealthpolicy/publichealth...
    - close04 7y ago
      Acute and chronic pain are different. The point isn't to find the cure that blocks all pain at all times, or to do it completely unsupervised. But under doctor supervision a real cure for chronic pain (not a load of opioids) would be a life changer for so many people.
    - ctrl-j 7y ago
      > Ignoring pain is akin to ignoring the "check engine light". I had surgery to remove a cyst that resulted in some scar tissue developing that presses on a nerve when stretched or compressed. Pretty acute pain when that happens - and pretty constant low level pain otherwise. No real "cure" as the odds are very high that the scar tissue will just re-form when excised. In my case it's more like the "check engine light" was rewired to also light up when you press the clutch pedal. Sometimes all you can do is put some electrical tape over the light.
    - rjurney 7y ago
      Unfortunately most chronic pain has no clear cause. That's why spinal surgery is much more discouraged these days for spinal pain. Artifacts on spinal MRIs for example are only slightly correlated with pain. Many people have severe problems in their spine and no chronic spinal pain and many people have no clear problem and terrible spinal pain. The nervous system is complicated and there are a lot of risk factors for developing chronic pain: job dissatisfaction, sitting all day long, depression, repetitive strain, stress, etc. And no, it isn't mental or psychosomatic, it's very real. It's in the peripheral nervous system and the base of the brain.
- sebiche 7y ago
  Did you read the article? It mentions fibromyalgia, which is a chronic pain condition with an unknown root cause. If you have any information the rest of the world doesn't have regarding the root cause of it, maybe you should have made that your comment instead of a cliche aphorism.
  - erentz 7y ago
    It's not quite as unknown as commonly believed. At least 40% of fibromyalgia have observable neuropathy on biopsies pointing to a process that is damaging nerves. The "what" is still unknown. But the parent is correct to say for fibromyalgia patients the optimal solution is a treatment (or cure) targeting that damaging process, rather than a pain killer. This is not to say better pain killers aren't valuable, they obviously are, it's just that for many of these chronic pain disorders there is some underlying cause that if we can treat would be the better solution.
    - misnome 7y ago
      This is a bit like, and as helpful as, saying “Chemotherapy is pointless, just find a cure for the cancer”
      - erentz 7y ago
        No, that doesn't really make sense. Note in your example of cancer that pain killers are in fact given to cancer patients, they're one of the biggest users of our strongest pain killers. But nobody claims painkillers treat the cancer. So how could we claim pain killers treat other illnesses such as fibromyalgia? Chemotherapy is a treatment that targets the actual cause of the pain (the cancer) and (hopefully) kills it, leading to remission and (hopefully) return to normal function of the person as a cancer free individual. A pain killer is something that does not target the cause of pain, does not treat or reverse or cause remission for that cause, and does not cause the individual to be illness free. It just makes the person feel less pain, so they can be more comfortable.
      - proverbialbunny 7y ago
- threehams 7y ago
  Pain is sometimes a symptom of something else. The overwhelming belief that pain is always a symptom of something else has held back research for decades. "At least initially, a clinician probably will assume pain is a symptom of some underlying condition and prescribe analgesics, while focusing on discovering what the underlying problem might be. But if a cause cannot be found, if early treatments fail to bring improvement, and if pain persists for several months, it may progress to the point where it becomes a disease in itself, that is, an abnormal condition that impairs or disrupts normal bodily functioning (this is almost always chronic pain). Then, regardless of the initiating process, cause, or underlying disease, the clinician must focus on management of the pain condition in order to assist in restoring the individual to a better state of health. This is not to say that all pain is a serious disease. When pain is a disease in itself, however, it requires comprehensive assessment, care planning, and treatment." From the peer-reviewed source: https://www.ncbi.nlm.nih.gov/books/NBK92517/ https://www.ncbi.nlm.nih.gov/books/NBK92517/
  - rjurney 7y ago
    Thank you so much! So much terrible information at the top of this page, really shows the weaknesses of the upvote model here.
- dsfyu404ed 7y ago
  When it's a symptom of some part of your body being worn out there's usually no treating that.
  - Wistar 7y ago
    No wonder I get headaches these days.
  - proverbialbunny 7y ago
    Actually, that is a common issue with chronic pain, and thankfully that's far from the truth. Chronic pain clinics have a physical therapist that shows muscle building exercises, so the body stops being worn out. However, depending on what the kind of wear is, as paradoxical as it seems, going for a walk for at least 20 minutes, can charge an exhausted body more than laying down without napping.
- codr7 7y ago
  What if the root cause is something that's simply broken? Like a smashed vertibrae in my case. The root cause was falling from a cliff without any protection besides a helmet.
- rjurney 7y ago
  This is not medical reality. Chronic pain is usually caused by an up-modulation of pain transmission in the peripheral and central nervous system. It is totally distinct from acute, short term pain with a clear cause. It is treated differently, responds differently to medications and is generally a horrible malady compared to acute pain.
Cannibusted 7y ago
Tramadol works great for my chronic pain.
- searine 7y ago
  Opioids work wonders for chronic pain, the downside being obvious, but when used responsibly they are a lifesaver. Lurk any chronic pain support group and you will find hundreds of people terrified of going back to the dark ages before opioids. Over-enforcement of the epidemic is real and doing damage to already damaged people.
- babyslothzoo 7y ago
  That's because opioids remain the single most effective pain treatment that humans have available. People have been using them for 4000+ years, they have a long track record of efficacy (and safety). Managing pain with opioids is not much different than managing diabetes with insulin. I realize the media mania and moral panic doesn't convey that because it doesn't fit the hype narrative, but there is a huge difference between medical patients and drug abusers.
  - rjurney 7y ago
    The opioid action of Tramadol is far less than Codeine. That's mostly not how it works.
avgDev 7y ago
Oof. To answer the headline, there already is a cure to chronic pain and it is called correct diagnosis. When i was 21 I had chronic pain for 8 months, doctors gave me anti-biotics, NSAIDS, steroids.....but pain was just there. After months of research I found a surgeon in California, who performed surgeries on "Sports Hernia", almost like inguinal hernia without any bumps. I flew out to have the surgery, pictures taken during showed almost total rips of internal/external obliques in my groin area. This was not picked up by an MRI, as specific MRI settings need to be used. When I called different MRI places to talk about settings they did not know what the hell I was talking about. If I did not do my own research, I would literally still be living with this pain. I mentioned sports hernia to at least 4 doctors and they said it is "rare". Oddly enough I have symptoms of fibro, after flouroquinolone antibiotics reaction. It is very frustrating that doctors are ignoring the cause and going straight to medicating. Side effects of these drugs are widely under-reported, and many fibromyalgia patients actually are suffering from FQAD, which is flouroquinolone associated disability. It affects the neurological system and tendons/muscles. There is some new research coming to the surface talking about possible mtDNA toxicity. This would be better treated with supplements that support mitochondria, rather than medication. Also, best treatment for tendinitis is eccentric exercise not NSAIDs or steroids. Additionally, by focusing on treating pain only when there is widespread tendon issue for example, patients are feeling better, therefore, putting more load on tendons, leading to more damage but hey at least they are hooked on opiates, cymbalta or any other wonder drug they come up with. I'm not saying there is no place for medicating pain, when pain is due to scar tissue, nerve damage or other. I just have a problem with doctors tossing whatever medication they can without doing proper research.
- searine 7y ago
  >there already is a cure to chronic pain and it is called correct diagnosis. There are many many conditions where even with a proper diagnosis there is little help. One of the easiest things to do with chronic pain patients is to minimize or handwave their pain as transient. There is no surgery for many of these people. No drugs that aren't heavily addictive. Little to no hope of anything but a lifetime of pain.
  - 7y ago
sdegutis 7y ago
Although there is value in trying to removing pain when doing so would be ethical, this thread mentions many situations where there is pain but no possibility yet of removing or reducing it. In these cases, a long-term general solution is to continue research on these situations. But the short-term solution per person is to learn the meaning and value of suffering. It is frowned upon in intellectual forums to discuss religion, as if religion were incompatible with logic and reason. But Jesus came to teach us how to endure suffering without failing in our duties. That is what he did, what he showed us how to do, and what he gives us the power to do through the Sacraments, especially Holy Communion. Because this is true power: to endure suffering without failing. And evil means failure because it is an absence of power to do what is both good and proper; sin is simply a lack of power. You will not learn any of this in any philosophy or world-religions class, or intellectual discussions over caviar. You will only learn and understand this through experiencing it, which can only be started by a humble trust that Jesus came into this world to suffer and die for our sake, out of love for us, and he will teach us how to do good, even in the midst of suffering. He knows our pain better than we do. He suffered more than we ever could.
- searine 7y ago
  Jesus died on the cross in six hours. Let's see jesus crush a few vertebrae and live disabled for 40 years without pain meds, and then talk about suffering. Like I get it. Religion does help many, and it can take you away from pain, but suffering is real and don't shortchange people's misery who are dealing with it.
  - sdegutis 7y ago
    I'm deeply sorry for your suffering. 40 years is a very long time, and it's not a coincidence that throughout history 40 has been the number representing trial and suffering. Jesus does know what you have gone through. He's not "some religion" but a person. He can help you. He's the only one who can help you.
  - faissaloo 7y ago
    Jesus (PBUH) was never put on the cross, they crucified the wrong guy.
mjevans 7y ago
Answering the headline: maybe, when we finish getting out of the 'steam age' of medicine. Long term might grow closer to current science fiction. Very precise robotic surgery at an atomic level reconstructs whole bodies (my favorite case being the beginning of The Fifth Element), less extreme examples also exist and we might someday get to the point where "knives" are replaced with gentle 'unzipping' tools or even grey-goo that slowly scrubs over an area and just sets everything correct.
Wistar 7y ago
Perhaps naive but from NPR this morning: "For people who live with chronic pain, getting up, out and moving can seem daunting. Some fear that physical activity will make their pain worse. But in fact, researchers find the opposite is true: The right kind of exercise can help reduce pain." https://www.npr.org/sections/health-shots/2019/09/23/754869132/exercising-to-ease-pain-taking-brisk-walks-can-help https://www.npr.org/sections/health-shots/2019/09/23/7548691...
- rjurney 7y ago
  This is true to some extent - use it or lose it. They also teach you to know your limits so your pain doesn't flareup and put you in bed for a week. You learn this delicate balance this over time, to push yourself just enough but not too much. At first you hurt yourself constantly because your body can do whatever you want - right? But no. Not now. That fact doesn't really make it easier to get out of bed. Your brain tells you not to move, that you're injured. Rest. Its an animal thing. You have to overcome it each morning, and all day long. And unfortunately that takes energy. It drains you. You have much less capacity as a result. Everything in life is harder. You do the best you can. This is the reality of disability. It fucking sucks.
- jrace 7y ago
  And this is where using pain meds can help. Get the pain down to a lower level and then you can attempt to do normal functions. Key being not so much pain reduction that you can cause physical harm (masking good pain response). I know (second hand) what chronic pain can do to the desire to get up and function. It destroys it. My SO has lived with it for almost 20 years now, and is due to live with it the rest of her life. There is no cure for her condition. You cannot fix the root cause (sympathetic nerve dysfunction) She can only hope to numb the signals to allow her to see past the pain.
- justinator 7y ago
  "Motion is Lotion"!
- GordonS 7y ago
  I can understand how, for some conditions, exercise could help, not just physically, but against the depressing effects of chronic pain. But absolutely not for all conditions. For too long, doctors have pushed graded exercise programs for essentially all chronic pain conditions, despite good evidence that it can be harmful, even permanently, for some conditions (e.g. CFS). I personally suffer from chronic pain, caused by small fiber neuropathy. I used to love walking, and I want to exercise - but if I do too much it can take days or even weeks to recover. A few times, I'm fairly sure I made things permanently (or hopefully semi-permanently) worse. So, yes, exercise does help some people, but we must be careful not to push it as the be all and end all.
nate 7y ago
Tangent from the article, but when I read the headline I thought I'd at least share in case it helps anyone who might have chronic pain like I've dealt with lately. For years now I've been suffering from tons of weird shit. I've had this persistent painful skin rash that pops up all over my body. Steroids would kill it for awhile but it would always come back. Folks would ask me if I had burned myself when they'd see places on my skin. Just chalked up to an allergy from my doctors (to what? many things they guessed). To top that fun off, my knees and one shoulder have been killing me. Had trouble walking up stairs. Couldn't do pull-ups anymore without extreme pain. I'd wake up in pain. Just constant pain. People just chalk that up to me getting older. Arthritis I guess. But then my wife felt like trying to do some Whole 30 kind of thing. I hate this stuff. But whatever. She needed support so I went along with it. Cut out gluten, dairy, alcohol, sugar. Low-carb. High protein. And after a week: I could move my arm above my head again. Walking up stairs became normal. Huh! Cool! I thought, maybe my body just needed a reset and gave that diet up. All this stuff came back. Now realize how important it is for me to stay on a low-carb diet. It doesn't seem to be gluten or dairy getting me. But sugar, alcohol and carbs. And I wouldn't say I was that bad at eating those before. But clearly I'm super sensitive to them. Today, I stay on a low-carb diet. I cheat on Saturdays. Allow myself to eat the nominal sugary treat and have a couple alcoholic drinks. But I barely want to since my life is just like a billion times better. All that joint pain is gone. My skin has cleared up. I'm doing pull ups again. Running a ton. Just did 8.5 miles today. So, all I know, is if you feel like shit constantly, it might be worth throwing sugar and alcohol away. Might be worth trying an elimination diet. I can't believe how long I laughed this stuff off when clearly it's so incredibly important and has transformed my life. Edit: I forgot to mention the brain fog I was living with too. There was a fluid in my ears screwing with my balance. Felt like I had a head cold. Also has cleared up.
- rjurney 7y ago
  Diet doesn't cure chronic pain. You obviously had some condition that wasn't chronic pain, where pain was a symptom of that disease.
  - virtuallynathan 7y ago
rjurney 7y ago
Acute pain is a symptom. Chronic pain is a disease. Most chronic pain is not directly connected with a root cause. Spinal MRIs for example are poor predictors of spinal pain. It is an upmodulation of pain sensation in the peripheral nervous system/brain stem. It isn't mental and it isn't psychosomatic - it is very real. And you can't just ignore it - although there are techniques in pain psychology that help. This is hopeful, but then so are Nerve Growth Factor drugs and it isn't looking too good for them at the moment. The second to last drug in trials failed the safety trial. At any moment we could learn the last drug failed as well, and then the entire group is DOA. Drug development is horrible to wait on, for people that badly need the drugs. Animal trials work in humans what, 10% of the time? This is great research, but it won't be a treatment for at least a decade, if ever :( Here's WebMD saying the same thing about what chronic pain is: https://www.webmd.com/pain-management/guide/cause-chronic-pain https://www.webmd.com/pain-management/guide/cause-chronic-pa... "In many cases, however, the source of chronic pain can be a very complex and even mysterious issue to untangle. Although it may begin with an injury or illness, ongoing pain can develop a psychological dimension after the physical problem has healed. This fact alone makes pinning down a single course of treatment tricky, and it is why health care providers often find they have to try a number of different types of curative steps." Psychological is wrong, there's nothing psychological about it - wrong part of the brain. The brain stem is not psychological, its neurological. Psychological techniques can help you cope, though.
- cpncrunch 7y ago
  Psychosomatic == real. If your heart rate increases when you are frightened, is that imaginary? While some research shows changes in the brainstem, fMRI shows differences in blood flow in various parts of the brain associated with processing emotions. Right now we don't have a definitive answer as to what causes chronic pain. But we do know for certain that the parts of the brain dealing with pain are also involved in emotional processing. It's actually very easy to demonstrate to yourself that pain can be psychosomatic. If you're riding your bike and imagine falling off, you will experience real pain. (At least, it happens for me, and I assume I'm not the only person who that happens to). Here is an interesting fMRI study looking at the effects of pain processing in both fibromyalgia patients and healthy participants: https://onlinelibrary.wiley.com/doi/abs/10.1016/j.ejpain.2008.06.010 https://onlinelibrary.wiley.com/doi/abs/10.1016/j.ejpain.200...
wetpaws 7y ago
As per https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline... the answer is no.
- DoreenMichele 7y ago
  Let's hope so. No sense of pain can result in severe self-inflicted injuries and premature death https://www.independent.co.uk/life-style/health-and-families/health-news/the-people-who-cant-feel-pain-scientists-discover-cause-of-rare-inherited-condition-that-turns-off-10274604.html https://www.independent.co.uk/life-style/health-and-families...
jririi82zxn 7y ago
No. Or not in our lifetime, maybe is the better answer. My gut says a lot of “chronic pain” that ends up hardwiring the brain to be noticed. Reinforce a neural pathway often enough and it won’t quiet down. The buzz will be there and we can’t be sure our sore spot hurts or our brain simply can’t avoid that pathway. See phantom limb and similar.
- proverbialbunny 7y ago
  Kind of, kind of not. When one has enough chronic pain, they lay in bed for extended periods of time. This deteriorates the muscles, and a lack of muscle strength can create chronic pain, creating a feedback loop. It's why chronic pain centers prescribe a physical therapist and muscle strengthening exercises. Likewise, as you suspect when it comes to neurology, if something happens over and over again the brain creates a map for it, which when it comes to chronic pain can make things worse. One of the solutions found is to prescribe an antidepressant, even if the person isn't depressed, as it helps rewire those kinds of parts of the brain. This is why at chronic pain centers there is a psychiatrist too. Once those two issues are reduced or removed the chronic pain is often minimized enough (and sometimes entirely removed) the source of the chronic pain can become easier to see. Often the pain is still there, but it's no longer masked. This then helps identify the issue. eg for me, despite being 20/20 I have eye strain. Switching to a 4k monitor helped a lot, but I wouldn't have noticed a reduction in pain if I hadn't have gone through the physical therapy and been on an antidepressant for a couple of months.
einpoklum 7y ago
> Will there ever be a cure for chronic pain? This is like asking "Will there be a cure for chronic being-sick?" - this is meaningless. Chronic pain has innumerable possible causes. Suppressing the symptoms to stuff is not a cure.
- ericb 7y ago
  If you look at the causal end, sure. But if you look at the symptom side, why not? At the end of the day, pain is reducible to neurons firing in succession. If you can stop it, interrupt it, filter it or block it, you would have something.
dghughes 7y ago
My dad has rheumatoid arthritis and is in constant pain. Even humeria doesn't help much. Now I have started waking up in the morning with hands so stiff I can barely make a fist. The pain doesnt bother me as much as the fear of being doped up on opioids. And the fact organ damage goes along with rheumatoid arthritis. And to top it off every nut around you says weed or some diet will cure you. It's always cure not maintain or reduce but an outright cure.
- kirrent 7y ago
  I'm sure you're already on top of all of this and I hope you'll forgive the tangent, but if you're starting to get RA symptoms you should be acting now. It used to be the practice of rheumatologists to wait to treat until symptomatic relief was required by patients. That's no longer the case. The earlier you act and get on DMARDs (and you might even need to try a few before getting one that works or finding the one that works best. Humira was completely ineffective for me), the less cumulative joint erosion you'll experience, the sooner you'll likely be in remission, and the more likely you'll be to experience a later sustained DMARD-free remission. Even if that's not the case and DMARDs don't completely solve the problem for you, there's a lot of options before opiods for symptomatic relief. From panadol, through NSAIDs (including the magical COX-2 selectives), and even steroidals. Don't give up hope too early. Three years ago I couldn't dress myself. Today I just got back from a rock climbing holiday.
  - dghughes 7y ago
    Thanks for the advice but even if the doctor told dad all that I'm not sure he'd understand. I've heard of DMARDs but never read up on them if I did tried to explain it to dad he'd never sit still to listen. He's still quite strong sick as he is and age 76 he lifted and emptied a large bucket of rocks, then complained of shoulder pain. I think dementia and old age are a factor here too, poor judgement. People laugh at the joke "if that hurts don't do that" but it's too true. He's on a couple of strong pain meds and steroids. He's a bit better now that he started oxygen he doesn't look as pale. I'm glad to hear you're doing well it's a terrible disease not like there's a good disease. Just make sure to keep an eye on your lungs.
anm89 7y ago
This is a nonsensical premise to me masked by the fact that we use one phrase "chronic pain" to represent a huge range of experiences. And then because we have this one phrase we throw the other word cure in front of it like this semantic trick represents the possibility of achieving it. I don't buy it. Chronic pain is a thousand different problems and I think it will be solved piece by piece by debugging those individual problems.
sjg007 7y ago
Sure, there is always the placebo effect possibly. There is a question though of those who kill themselves after they've been stung by some kind of snake or wasp that is apparently so painful that death is the only relief.
AnnaJustin 7y ago
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83 points by prostoalex 7y ago

Should there be one? Pain is a symptom of something else, treat the root cause. Managing pain should only be a temporary measure.

theobon 7y ago
This is well understood by pain researchers and the article explicitly mentions that they are trying to find solutions that address chronic pain without impacting the pain responses you are referring to. "The team bred genetically engineered mice from embryos that had HCN2 excised from their DNA. Subsequent experiments showed that these mice did not develop neuropathic pain (the kind that affects the nervous system and is often caused by long-term conditions such as cancer or diabetes). Not only that, the mice with HCN2 cut out were still able to feel acute pain – the necessary, protective jolt that tells us to remove our finger from a drawing pin. “That’s the holy grail,” McNaughton told me"
_eht 7y ago
This is a limited scope viewpoint.
viklove 7y ago
You've clearly never had a surgery. Many invasive surgeries can result in lifelong pain with no underlying cause. Having a doctor muck about with your internals leaves nerve endings in the wrong place and scar tissue that will never heal. Source: Had two pneumothoraces that resulted in lung surgery years ago, still get pain every day that I just have to ignore.
- ed312 7y ago
  While the parent is being a bit crass, there is a valuable underlying point. Ignoring pain is akin to ignoring the "check engine light". We (as a society) should really try to figure out the root causes AND (not or) find more targeted pain management. Perhaps your pain can be safely ignored (from a medical point of view). Perhaps its truly a signal there is a new or greater risk.
  - viklove 7y ago
    Well as you can imagine, chest pain is rather worrying. I've been to the ER and seen various doctors (and had a lot of xrays and CT scans done). They haven't found anything, and told me it's to be expected with the surgeries I've been through. Humans aren't engineered like vehicles. Sometimes you just have a faulty "check engine light" and there's nothing you can do about it.
  - johnfactorial 7y ago
    Pain was once considered a fact of life, and vital signs were those 4 signs which can indicate a patient is alive: body temp, pulse, respiratory rate, and blood pressure. Then the notion of pain as the "fifth vital sign," came about. Some argue we resultantly now have an opioid epidemic. There is a fascinating NPR show episode on this topic: https://www.npr.org/programs/invisibilia/701219878/the-fifth-vital-sign https://www.npr.org/programs/invisibilia/701219878/the-fifth.... Edit: another source of info: https://www.medpagetoday.com/publichealthpolicy/publichealth/57336 https://www.medpagetoday.com/publichealthpolicy/publichealth...
  - close04 7y ago
    Acute and chronic pain are different. The point isn't to find the cure that blocks all pain at all times, or to do it completely unsupervised. But under doctor supervision a real cure for chronic pain (not a load of opioids) would be a life changer for so many people.
  - ctrl-j 7y ago
    > Ignoring pain is akin to ignoring the "check engine light". I had surgery to remove a cyst that resulted in some scar tissue developing that presses on a nerve when stretched or compressed. Pretty acute pain when that happens - and pretty constant low level pain otherwise. No real "cure" as the odds are very high that the scar tissue will just re-form when excised. In my case it's more like the "check engine light" was rewired to also light up when you press the clutch pedal. Sometimes all you can do is put some electrical tape over the light.
  - rjurney 7y ago
    Unfortunately most chronic pain has no clear cause. That's why spinal surgery is much more discouraged these days for spinal pain. Artifacts on spinal MRIs for example are only slightly correlated with pain. Many people have severe problems in their spine and no chronic spinal pain and many people have no clear problem and terrible spinal pain. The nervous system is complicated and there are a lot of risk factors for developing chronic pain: job dissatisfaction, sitting all day long, depression, repetitive strain, stress, etc. And no, it isn't mental or psychosomatic, it's very real. It's in the peripheral nervous system and the base of the brain.
sebiche 7y ago
Did you read the article? It mentions fibromyalgia, which is a chronic pain condition with an unknown root cause. If you have any information the rest of the world doesn't have regarding the root cause of it, maybe you should have made that your comment instead of a cliche aphorism.
- erentz 7y ago
  It's not quite as unknown as commonly believed. At least 40% of fibromyalgia have observable neuropathy on biopsies pointing to a process that is damaging nerves. The "what" is still unknown. But the parent is correct to say for fibromyalgia patients the optimal solution is a treatment (or cure) targeting that damaging process, rather than a pain killer. This is not to say better pain killers aren't valuable, they obviously are, it's just that for many of these chronic pain disorders there is some underlying cause that if we can treat would be the better solution.
  - misnome 7y ago
    This is a bit like, and as helpful as, saying “Chemotherapy is pointless, just find a cure for the cancer”
    - erentz 7y ago
      No, that doesn't really make sense. Note in your example of cancer that pain killers are in fact given to cancer patients, they're one of the biggest users of our strongest pain killers. But nobody claims painkillers treat the cancer. So how could we claim pain killers treat other illnesses such as fibromyalgia? Chemotherapy is a treatment that targets the actual cause of the pain (the cancer) and (hopefully) kills it, leading to remission and (hopefully) return to normal function of the person as a cancer free individual. A pain killer is something that does not target the cause of pain, does not treat or reverse or cause remission for that cause, and does not cause the individual to be illness free. It just makes the person feel less pain, so they can be more comfortable.
    - proverbialbunny 7y ago
threehams 7y ago
Pain is sometimes a symptom of something else. The overwhelming belief that pain is always a symptom of something else has held back research for decades. "At least initially, a clinician probably will assume pain is a symptom of some underlying condition and prescribe analgesics, while focusing on discovering what the underlying problem might be. But if a cause cannot be found, if early treatments fail to bring improvement, and if pain persists for several months, it may progress to the point where it becomes a disease in itself, that is, an abnormal condition that impairs or disrupts normal bodily functioning (this is almost always chronic pain). Then, regardless of the initiating process, cause, or underlying disease, the clinician must focus on management of the pain condition in order to assist in restoring the individual to a better state of health. This is not to say that all pain is a serious disease. When pain is a disease in itself, however, it requires comprehensive assessment, care planning, and treatment." From the peer-reviewed source: https://www.ncbi.nlm.nih.gov/books/NBK92517/ https://www.ncbi.nlm.nih.gov/books/NBK92517/
- rjurney 7y ago
  Thank you so much! So much terrible information at the top of this page, really shows the weaknesses of the upvote model here.
dsfyu404ed 7y ago
When it's a symptom of some part of your body being worn out there's usually no treating that.
- Wistar 7y ago
  No wonder I get headaches these days.
- proverbialbunny 7y ago
  Actually, that is a common issue with chronic pain, and thankfully that's far from the truth. Chronic pain clinics have a physical therapist that shows muscle building exercises, so the body stops being worn out. However, depending on what the kind of wear is, as paradoxical as it seems, going for a walk for at least 20 minutes, can charge an exhausted body more than laying down without napping.
codr7 7y ago
What if the root cause is something that's simply broken? Like a smashed vertibrae in my case. The root cause was falling from a cliff without any protection besides a helmet.
rjurney 7y ago
This is not medical reality. Chronic pain is usually caused by an up-modulation of pain transmission in the peripheral and central nervous system. It is totally distinct from acute, short term pain with a clear cause. It is treated differently, responds differently to medications and is generally a horrible malady compared to acute pain.

Cannibusted 7y ago

Tramadol works great for my chronic pain.

searine 7y ago
Opioids work wonders for chronic pain, the downside being obvious, but when used responsibly they are a lifesaver. Lurk any chronic pain support group and you will find hundreds of people terrified of going back to the dark ages before opioids. Over-enforcement of the epidemic is real and doing damage to already damaged people.
babyslothzoo 7y ago
That's because opioids remain the single most effective pain treatment that humans have available. People have been using them for 4000+ years, they have a long track record of efficacy (and safety). Managing pain with opioids is not much different than managing diabetes with insulin. I realize the media mania and moral panic doesn't convey that because it doesn't fit the hype narrative, but there is a huge difference between medical patients and drug abusers.
- rjurney 7y ago
  The opioid action of Tramadol is far less than Codeine. That's mostly not how it works.

avgDev 7y ago

Oof. To answer the headline, there already is a cure to chronic pain and it is called correct diagnosis. When i was 21 I had chronic pain for 8 months, doctors gave me anti-biotics, NSAIDS, steroids.....but pain was just there. After months of research I found a surgeon in California, who performed surgeries on "Sports Hernia", almost like inguinal hernia without any bumps. I flew out to have the surgery, pictures taken during showed almost total rips of internal/external obliques in my groin area. This was not picked up by an MRI, as specific MRI settings need to be used. When I called different MRI places to talk about settings they did not know what the hell I was talking about. If I did not do my own research, I would literally still be living with this pain. I mentioned sports hernia to at least 4 doctors and they said it is "rare". Oddly enough I have symptoms of fibro, after flouroquinolone antibiotics reaction. It is very frustrating that doctors are ignoring the cause and going straight to medicating. Side effects of these drugs are widely under-reported, and many fibromyalgia patients actually are suffering from FQAD, which is flouroquinolone associated disability. It affects the neurological system and tendons/muscles. There is some new research coming to the surface talking about possible mtDNA toxicity. This would be better treated with supplements that support mitochondria, rather than medication. Also, best treatment for tendinitis is eccentric exercise not NSAIDs or steroids. Additionally, by focusing on treating pain only when there is widespread tendon issue for example, patients are feeling better, therefore, putting more load on tendons, leading to more damage but hey at least they are hooked on opiates, cymbalta or any other wonder drug they come up with. I'm not saying there is no place for medicating pain, when pain is due to scar tissue, nerve damage or other. I just have a problem with doctors tossing whatever medication they can without doing proper research.

searine 7y ago
>there already is a cure to chronic pain and it is called correct diagnosis. There are many many conditions where even with a proper diagnosis there is little help. One of the easiest things to do with chronic pain patients is to minimize or handwave their pain as transient. There is no surgery for many of these people. No drugs that aren't heavily addictive. Little to no hope of anything but a lifetime of pain.
- 7y ago

sdegutis 7y ago

Although there is value in trying to removing pain when doing so would be ethical, this thread mentions many situations where there is pain but no possibility yet of removing or reducing it. In these cases, a long-term general solution is to continue research on these situations. But the short-term solution per person is to learn the meaning and value of suffering. It is frowned upon in intellectual forums to discuss religion, as if religion were incompatible with logic and reason. But Jesus came to teach us how to endure suffering without failing in our duties. That is what he did, what he showed us how to do, and what he gives us the power to do through the Sacraments, especially Holy Communion. Because this is true power: to endure suffering without failing. And evil means failure because it is an absence of power to do what is both good and proper; sin is simply a lack of power. You will not learn any of this in any philosophy or world-religions class, or intellectual discussions over caviar. You will only learn and understand this through experiencing it, which can only be started by a humble trust that Jesus came into this world to suffer and die for our sake, out of love for us, and he will teach us how to do good, even in the midst of suffering. He knows our pain better than we do. He suffered more than we ever could.

searine 7y ago
Jesus died on the cross in six hours. Let's see jesus crush a few vertebrae and live disabled for 40 years without pain meds, and then talk about suffering. Like I get it. Religion does help many, and it can take you away from pain, but suffering is real and don't shortchange people's misery who are dealing with it.
- sdegutis 7y ago
  I'm deeply sorry for your suffering. 40 years is a very long time, and it's not a coincidence that throughout history 40 has been the number representing trial and suffering. Jesus does know what you have gone through. He's not "some religion" but a person. He can help you. He's the only one who can help you.
- faissaloo 7y ago
  Jesus (PBUH) was never put on the cross, they crucified the wrong guy.

mjevans 7y ago

Answering the headline: maybe, when we finish getting out of the 'steam age' of medicine. Long term might grow closer to current science fiction. Very precise robotic surgery at an atomic level reconstructs whole bodies (my favorite case being the beginning of The Fifth Element), less extreme examples also exist and we might someday get to the point where "knives" are replaced with gentle 'unzipping' tools or even grey-goo that slowly scrubs over an area and just sets everything correct.

Wistar 7y ago

Perhaps naive but from NPR this morning: "For people who live with chronic pain, getting up, out and moving can seem daunting. Some fear that physical activity will make their pain worse. But in fact, researchers find the opposite is true: The right kind of exercise can help reduce pain." https://www.npr.org/sections/health-shots/2019/09/23/754869132/exercising-to-ease-pain-taking-brisk-walks-can-help https://www.npr.org/sections/health-shots/2019/09/23/7548691...

rjurney 7y ago
This is true to some extent - use it or lose it. They also teach you to know your limits so your pain doesn't flareup and put you in bed for a week. You learn this delicate balance this over time, to push yourself just enough but not too much. At first you hurt yourself constantly because your body can do whatever you want - right? But no. Not now. That fact doesn't really make it easier to get out of bed. Your brain tells you not to move, that you're injured. Rest. Its an animal thing. You have to overcome it each morning, and all day long. And unfortunately that takes energy. It drains you. You have much less capacity as a result. Everything in life is harder. You do the best you can. This is the reality of disability. It fucking sucks.
jrace 7y ago
And this is where using pain meds can help. Get the pain down to a lower level and then you can attempt to do normal functions. Key being not so much pain reduction that you can cause physical harm (masking good pain response). I know (second hand) what chronic pain can do to the desire to get up and function. It destroys it. My SO has lived with it for almost 20 years now, and is due to live with it the rest of her life. There is no cure for her condition. You cannot fix the root cause (sympathetic nerve dysfunction) She can only hope to numb the signals to allow her to see past the pain.
justinator 7y ago
"Motion is Lotion"!
GordonS 7y ago
I can understand how, for some conditions, exercise could help, not just physically, but against the depressing effects of chronic pain. But absolutely not for all conditions. For too long, doctors have pushed graded exercise programs for essentially all chronic pain conditions, despite good evidence that it can be harmful, even permanently, for some conditions (e.g. CFS). I personally suffer from chronic pain, caused by small fiber neuropathy. I used to love walking, and I want to exercise - but if I do too much it can take days or even weeks to recover. A few times, I'm fairly sure I made things permanently (or hopefully semi-permanently) worse. So, yes, exercise does help some people, but we must be careful not to push it as the be all and end all.

nate 7y ago

Tangent from the article, but when I read the headline I thought I'd at least share in case it helps anyone who might have chronic pain like I've dealt with lately. For years now I've been suffering from tons of weird shit. I've had this persistent painful skin rash that pops up all over my body. Steroids would kill it for awhile but it would always come back. Folks would ask me if I had burned myself when they'd see places on my skin. Just chalked up to an allergy from my doctors (to what? many things they guessed). To top that fun off, my knees and one shoulder have been killing me. Had trouble walking up stairs. Couldn't do pull-ups anymore without extreme pain. I'd wake up in pain. Just constant pain. People just chalk that up to me getting older. Arthritis I guess. But then my wife felt like trying to do some Whole 30 kind of thing. I hate this stuff. But whatever. She needed support so I went along with it. Cut out gluten, dairy, alcohol, sugar. Low-carb. High protein. And after a week: I could move my arm above my head again. Walking up stairs became normal. Huh! Cool! I thought, maybe my body just needed a reset and gave that diet up. All this stuff came back. Now realize how important it is for me to stay on a low-carb diet. It doesn't seem to be gluten or dairy getting me. But sugar, alcohol and carbs. And I wouldn't say I was that bad at eating those before. But clearly I'm super sensitive to them. Today, I stay on a low-carb diet. I cheat on Saturdays. Allow myself to eat the nominal sugary treat and have a couple alcoholic drinks. But I barely want to since my life is just like a billion times better. All that joint pain is gone. My skin has cleared up. I'm doing pull ups again. Running a ton. Just did 8.5 miles today. So, all I know, is if you feel like shit constantly, it might be worth throwing sugar and alcohol away. Might be worth trying an elimination diet. I can't believe how long I laughed this stuff off when clearly it's so incredibly important and has transformed my life. Edit: I forgot to mention the brain fog I was living with too. There was a fluid in my ears screwing with my balance. Felt like I had a head cold. Also has cleared up.

rjurney 7y ago
Diet doesn't cure chronic pain. You obviously had some condition that wasn't chronic pain, where pain was a symptom of that disease.
- virtuallynathan 7y ago

rjurney 7y ago

Acute pain is a symptom. Chronic pain is a disease. Most chronic pain is not directly connected with a root cause. Spinal MRIs for example are poor predictors of spinal pain. It is an upmodulation of pain sensation in the peripheral nervous system/brain stem. It isn't mental and it isn't psychosomatic - it is very real. And you can't just ignore it - although there are techniques in pain psychology that help. This is hopeful, but then so are Nerve Growth Factor drugs and it isn't looking too good for them at the moment. The second to last drug in trials failed the safety trial. At any moment we could learn the last drug failed as well, and then the entire group is DOA. Drug development is horrible to wait on, for people that badly need the drugs. Animal trials work in humans what, 10% of the time? This is great research, but it won't be a treatment for at least a decade, if ever :( Here's WebMD saying the same thing about what chronic pain is: https://www.webmd.com/pain-management/guide/cause-chronic-pain https://www.webmd.com/pain-management/guide/cause-chronic-pa... "In many cases, however, the source of chronic pain can be a very complex and even mysterious issue to untangle. Although it may begin with an injury or illness, ongoing pain can develop a psychological dimension after the physical problem has healed. This fact alone makes pinning down a single course of treatment tricky, and it is why health care providers often find they have to try a number of different types of curative steps." Psychological is wrong, there's nothing psychological about it - wrong part of the brain. The brain stem is not psychological, its neurological. Psychological techniques can help you cope, though.

cpncrunch 7y ago
Psychosomatic == real. If your heart rate increases when you are frightened, is that imaginary? While some research shows changes in the brainstem, fMRI shows differences in blood flow in various parts of the brain associated with processing emotions. Right now we don't have a definitive answer as to what causes chronic pain. But we do know for certain that the parts of the brain dealing with pain are also involved in emotional processing. It's actually very easy to demonstrate to yourself that pain can be psychosomatic. If you're riding your bike and imagine falling off, you will experience real pain. (At least, it happens for me, and I assume I'm not the only person who that happens to). Here is an interesting fMRI study looking at the effects of pain processing in both fibromyalgia patients and healthy participants: https://onlinelibrary.wiley.com/doi/abs/10.1016/j.ejpain.2008.06.010 https://onlinelibrary.wiley.com/doi/abs/10.1016/j.ejpain.200...

wetpaws 7y ago

As per https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline... the answer is no.

DoreenMichele 7y ago
Let's hope so. No sense of pain can result in severe self-inflicted injuries and premature death https://www.independent.co.uk/life-style/health-and-families/health-news/the-people-who-cant-feel-pain-scientists-discover-cause-of-rare-inherited-condition-that-turns-off-10274604.html https://www.independent.co.uk/life-style/health-and-families...

jririi82zxn 7y ago

No. Or not in our lifetime, maybe is the better answer. My gut says a lot of “chronic pain” that ends up hardwiring the brain to be noticed. Reinforce a neural pathway often enough and it won’t quiet down. The buzz will be there and we can’t be sure our sore spot hurts or our brain simply can’t avoid that pathway. See phantom limb and similar.

proverbialbunny 7y ago
Kind of, kind of not. When one has enough chronic pain, they lay in bed for extended periods of time. This deteriorates the muscles, and a lack of muscle strength can create chronic pain, creating a feedback loop. It's why chronic pain centers prescribe a physical therapist and muscle strengthening exercises. Likewise, as you suspect when it comes to neurology, if something happens over and over again the brain creates a map for it, which when it comes to chronic pain can make things worse. One of the solutions found is to prescribe an antidepressant, even if the person isn't depressed, as it helps rewire those kinds of parts of the brain. This is why at chronic pain centers there is a psychiatrist too. Once those two issues are reduced or removed the chronic pain is often minimized enough (and sometimes entirely removed) the source of the chronic pain can become easier to see. Often the pain is still there, but it's no longer masked. This then helps identify the issue. eg for me, despite being 20/20 I have eye strain. Switching to a 4k monitor helped a lot, but I wouldn't have noticed a reduction in pain if I hadn't have gone through the physical therapy and been on an antidepressant for a couple of months.

einpoklum 7y ago

> Will there ever be a cure for chronic pain? This is like asking "Will there be a cure for chronic being-sick?" - this is meaningless. Chronic pain has innumerable possible causes. Suppressing the symptoms to stuff is not a cure.

ericb 7y ago
If you look at the causal end, sure. But if you look at the symptom side, why not? At the end of the day, pain is reducible to neurons firing in succession. If you can stop it, interrupt it, filter it or block it, you would have something.

dghughes 7y ago

My dad has rheumatoid arthritis and is in constant pain. Even humeria doesn't help much. Now I have started waking up in the morning with hands so stiff I can barely make a fist. The pain doesnt bother me as much as the fear of being doped up on opioids. And the fact organ damage goes along with rheumatoid arthritis. And to top it off every nut around you says weed or some diet will cure you. It's always cure not maintain or reduce but an outright cure.

kirrent 7y ago
I'm sure you're already on top of all of this and I hope you'll forgive the tangent, but if you're starting to get RA symptoms you should be acting now. It used to be the practice of rheumatologists to wait to treat until symptomatic relief was required by patients. That's no longer the case. The earlier you act and get on DMARDs (and you might even need to try a few before getting one that works or finding the one that works best. Humira was completely ineffective for me), the less cumulative joint erosion you'll experience, the sooner you'll likely be in remission, and the more likely you'll be to experience a later sustained DMARD-free remission. Even if that's not the case and DMARDs don't completely solve the problem for you, there's a lot of options before opiods for symptomatic relief. From panadol, through NSAIDs (including the magical COX-2 selectives), and even steroidals. Don't give up hope too early. Three years ago I couldn't dress myself. Today I just got back from a rock climbing holiday.
- dghughes 7y ago
  Thanks for the advice but even if the doctor told dad all that I'm not sure he'd understand. I've heard of DMARDs but never read up on them if I did tried to explain it to dad he'd never sit still to listen. He's still quite strong sick as he is and age 76 he lifted and emptied a large bucket of rocks, then complained of shoulder pain. I think dementia and old age are a factor here too, poor judgement. People laugh at the joke "if that hurts don't do that" but it's too true. He's on a couple of strong pain meds and steroids. He's a bit better now that he started oxygen he doesn't look as pale. I'm glad to hear you're doing well it's a terrible disease not like there's a good disease. Just make sure to keep an eye on your lungs.

anm89 7y ago

This is a nonsensical premise to me masked by the fact that we use one phrase "chronic pain" to represent a huge range of experiences. And then because we have this one phrase we throw the other word cure in front of it like this semantic trick represents the possibility of achieving it. I don't buy it. Chronic pain is a thousand different problems and I think it will be solved piece by piece by debugging those individual problems.

sjg007 7y ago

Sure, there is always the placebo effect possibly. There is a question though of those who kill themselves after they've been stung by some kind of snake or wasp that is apparently so painful that death is the only relief.

AnnaJustin 7y ago

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