5 ms·

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

by juancn 7y ago

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.

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

by 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.