New drug target could change chronic pain medication

New research has uncovered a target for chronic and pathologic pain, which could lead to better drugs for those affected by pain in the future.

Chronic pain is “the most common cause of long-term disability,” according to the National Institutes of Health (NIH).

In fact, a recent analysis from the NIH estimates that more than 25 million people in the United States (or over 11 percent of the country’s adult population) live with chronic pain. This means that they have experienced pain every day for the past 3 months.

While in some cases chronic pain may have been initially triggered by an incident such as an injury or an infection, most of the time, the cause of chronic pain is unknown.

Because its causes remain largely unknown, chronic pain cannot yet be cured. However, drugs usually help, and researchers are hard at work trying to come up with more effective treatments.

Now, a new study – published in the journal PLOS Biology – has identified a potential novel therapeutic target for chronic pain, which could help researchers to develop an alternative medication to treat pain in the near future.

The team was led by Dr. Matthew Dalva, of the Department of Neuroscience at Thomas Jefferson University in Philadelphia, PA. He and his team have investigated a process called phosphorylation and its impact on how chronic pain occurs and what sensations it triggers.

Phosphorylation is a term that describes a common biological process whereby a protein changes in response to external stimuli.



 

Identifying a new pain receptor

Previous research has identified a pain receptor called N-methyl-D-aspartate (NMDA) and the fact that it plays a key role in pathologic pain.

However, this receptor is also important in memory and learning, so drugs that would target this receptor would also affect these functions.

But in the new study, Dr. Dalva and colleagues identified a second receptor that also plays a crucial role in pain. In their study, the scientists examined neurons in particular.

Specifically, by conducting a series of laboratory tests in cell cultures and in vivo, the team were able to see that, in response to injury-induced pain, the protein ephrin B modifies outside of the brain cell. This phosphorylation outside of the cell allows the ephrin B receptor to attach to the NMDA receptor, moving it into the synapses.

This process alters the function of the NMDA receptor, which leads to higher sensitivity to pain.

As the authors explain, pathologic pain differs from pain caused by an injury or inflammation because it is a result of cellular dysfunction.

Because pain occurs at the cellular level, it does not go away even after the initial cause has gone – as is the case with chronic pain or the common migraine.

For a cell to function properly, proteins must be in the right location. But what the new study shows is that in the case of chronic pain, the so-called process of phosphorylation “moves” the proteins away from the neuron, thus triggering cell dysfunction and pathologic pain.

Importantly, using a mouse model, the scientists were also able to test some chemicals that managed to block the unwanted synergy between the ephrin B receptor and the NMDA receptor.

Interrupting this communication between the two receptors stopped the pain. And conversely, bringing the two receptors together led to an excessive sensitivity to pain.

The senior author of the study comments on the significance of the findings, saying, “Because the protein modification that initiates nerve sensitivity to pain occurs outside of the cell, it offers us an easier target for drug development. This is a promising advance in the field of pain management.”

Although we have yet to discover the exact mechanism that causes this modification […] this finding offers both a target for developing new treatments and a strong new tool for studying synapses in general.”

Dr. Matthew Dalva

 


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Chronic Pain and an Active Lifestyle: Lessons in Recovery

If we want to better promote corporate wellness and if we want a workforce as productive as it is protective of its health, then we need to educate employers and employees alike about the best way to confront a problem affecting tens of millions of people and costing companies hundreds of millions of dollars. We need, in other words, to address the condition of chronic pain: A malady that is the result of muscle stiffness and inflammation, among other things, which can make it very difficult to sit, stand or move with the ease necessary to enjoy the quality of life these individuals deserve – and with the flexibility these men and women need to do their jobs.

Finding a noninvasive way to lessen this pain, one that does not require prescription drugs or surgery, is crucial to resolving this matter. It is essential to reviving the type of active lifestyle people want, the one that will keep them vibrant and healthy – in and outside their respective places of work.

With regard to that solution, technology offers promising results. Indeed, the rise of wearable technology like the Oska Pulse represent the union of convenience and wellness that will transform pain management for the better.

Can Low Back Pain Be Managed Without Surgery or Drugs?

Treating Nonspecific Low Back Pain

David Hanscom, MD, was just completing his training as a spine surgeon at Twin Cities Scoliosis Center in Minneapolis, Minnesota, in 1985, when his own horrible spine pain overtook him. “I was spiraling down,” he says. “Back pain, neck pain—I didn’t know how it hit me.”

Dr Hanscom had surgery for a ruptured disc, but it took him until 2002 to figure out that he could only escape the pain by controlling his stress and reprogramming his thoughts. Now working at Swedish Neuroscience Specialists in Seattle, Washington, Dr Hanscom offers a range of such therapies to his patients with chronic spine pain and prides himself on helping them avoid surgery altogether.

Nonspecific low back pain—that is, back pain without a specific diagnosis—has become a major public health problem worldwide, with a lifetime prevalence as high as 84%. And the prevalence of chronic low back pain is about 23%.[1]

Evidence is mounting for the efficacy of treating nonspecific chronic pain not with surgery or narcotic medications, but with therapies drawn from psychology and meditation. The research supporting cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) is particularly robust.[2]

But these approaches, particularly CBT, remain out of reach for many of the people who need them, says epidemiologist Dan Cherkin, PhD, MS, senior scientific investigator at the Group Health Research Institute in Seattle.

For one thing, not many psychologists are trained to offer CBT for pain management, Dr Cherkin notes.

For another, “a lot of the things that have been found effective for nonsurgical pain are not covered by insurance and not widely available,” he says. “It’s a wide social problem, and a training and reimbursement issue, that prevents patients from trying things that are shown to be effective.”

Reducing Pain by Changing Thoughts

Progress may depend on a more widespread understanding that the division between mind and body is artificial, says Dr Cherkin. Although its roots go back at least as far as the Greek Stoic philosopher Epictetus (55-135 AD), who stressed the importance of self-knowledge, CBT was developed by psychologists and psychiatrists in the mid-20th century as a treatment for mental health disorders.[2]Unlike many psychotherapies, CBT is guided by empirical research and focuses on solving problems in the present rather than uncovering trauma in the past.[2]

The researchers who developed CBT began with the premise that people can change unwelcome feelings and behavior by countering distorted thoughts behind them.

This process has a biochemical dimension. The emotional stress of pain may cause the release of adrenalin and cortisol, which increases conductivity of nerves, increasing the pain, Dr Hanscom explains. Over time, the nervous system may also adapt in such a way that the pain persists even after any physical trauma is healed.

“Anxiety is simply a chemical response to sensory inputs,” Dr Hanscom says. “The problem with thoughts, compared with the other stimuli, is that you can’t escape your thoughts. The harder you try to fight them, the worse it gets.”

With CBT, people can learn strategies for putting their fears into perspective. The therapy takes multiple forms, including one-on-one conversations with trained therapists, group treatments, reading, and writing.[3] Multiple studies have shown CBT to be effective in reducing back pain.[2]

In contrast, the origins of MBSR lie in Buddhist meditation and yoga. Molecular biologist Jon Kabbat-Zin, PhD, developed the first class in MBSR at the Massachusetts Medical Center in Worcester, Massachusetts, in 1979. In MBSR, the practitioner seeks to increase awareness and acceptance of such experiences as discomfort and negative emotions.[4] Although MBSR is less well-studied for back pain than is CBT, the research so far suggests that it may also be effective.[2]

Studies using MRI suggest that CBT and MBSR cause some brain remodeling

5 Tips to Cope With Chronic Pain

According to the Institute of Medicine, a whopping 100 million Americans—that’s one in three—suffer from some sort of chronic pain. And if you’re one of them, chances are at least one doctor has told you, “It’s all in your head.”chronic pain

The trick is that chronic pain wears many disguises. Sometimes chronic pain is psychosomatic, which does not mean it’s all in your head or that you’re faking (that’s another term: malingering), but does mean that your very real pain is caused by psychological factors, like stress or depression.

Other times, to everyone’s befuddlement, pain is caused by a mysterious injury that may or may not be visible on x-rays or MRIs. In other cases, there’s an underlying condition, like arthritis, fibromyalgia, or neuropathy. And if those weren’t enough options, sometimes chronic pain stems from damage to the the nerves and spinal cord—the pain system itself.

In the comprehensive book that inspired some of these tips, Managing Pain Before It Manages You, Dr. Margaret A. Caudill likens chronic pain to a fire alarm that keeps clanging long after the fire is out.

But whether your chronic pain stems from any of these four sources, it’s still, well, a pain. For those with migraines, back pain, joint pain, or anyone else who knows tension headaches are for amateurs, here are five tips to manage your chronic pain.

Tip #1: This pain is not your fault, but you are responsible for taking care of it.  In other words, own your pain. Hear me out on this one. Too often, we get caught up in existential rumination like why we have this pain or what we did to deserve this. Most often, we expect the health care system to rescue us and, when its fails, we get caught up in blame and anger. The result: tension builds, which leads to—you guessed it—more pain.  To stop the cycle, decide that you will be the driver of your pain. Doctors and therapists will be there to help, but you are in charge of your pain.

Tip #2: Be active. Hear me out on this one, too. It’s counterintuitive. You may think you should rest and protect the painful part of your body. You may be scared to move, for fear of more pain.

While rest is essential for acute pain, like a sprained ankle or a pulled muscle, rest reinforces chronic pain. As your muscles get weak and stiff from inactivity, the pain may actually intensify.

So do what activity you can—slowly ride a bike, walk, swim, do chair exercises. Find a gentle yoga class. Lift light weights. And don’t skip physical therapy.

An important trick is to break up exercise into shorter chunks—try for three 10-minute walks rather than one long walk. Also, try not to leave activity until late in the day—you’ll likely be too tired or simply unmotivated.

Being active has one last benefit: it makes you feel less like a prisoner of your pain. You can set goals, get outside, or team up with friends, all of which stave off depression and hopelessness in addition to reducing your pain.

Tip #3: Track your pain.  I know, I know, you don’t even want to think about your pain, much less keep track of it. But keeping a pain diary can help you make connections between what you do and how you feel.

So, take a week or two to track your activity during the day and how much pain you feel. You don’t have to track every detail—just broad strokes like “sat at my desk all morning” or “grocery shopping” will do. Then rate your pain—the classic from your doctor’s office is the 0-10 scale, where 0 is no pain and 10 is the worst pain you’ve ever experienced. Don’t be afraid to use the whole scale; you don’t want an unhelpful chart loaded with 5’s and nothing else.

Once you’ve tracked your pain for a week or two, look for patterns. Maybe you feel worse after time on your feet, after sitting at a computer, or on days after you’ve pushed yourself.

Use your newfound data to modify your environment and schedule. If sitting at your desk at work is killing your back, ask to have your chair evaluated or even aim for a standing desk. If your joint pain flares from preparing dinner, break it up into smaller chunks or delegate when you can.

Tip #4: Don’t push through it. It will get worse, I guarantee. So, resist getting indignant and showing the pain who’s boss. You may push through and accomplish everything on your to-do list, but the next morning you won’t be able to get out of bed.

Instead of strong-arming your pain, try a technique called pacing. The rule of pacing is to stop an activity before you’re in pain. Go by time, not task. Time how long you can comfortably do activities that are challenging for you, like typing, driving, or cleaning. Once you know your limits, aim to do those activities for less time than your limit, and then take a break before your pain flares.

For example, instead of powering through the dishes, do them for five minutes, then take a break and pay a bill. Then wash for five more minutes, and take a break to fold some laundry while sitting in a chair. Finally, finish up with five more minutes. It takes some work to change your habits, but it’s much easier to prevent pain than it is to quell it once you’re in the throes.

Tip #5: Question your beliefs about your pain. This is the big one. Your thoughts may be working against you. Remember what we said at the beginning: own your pain.  One way to do that is to question your old beliefs about pain.  You may find yourself saying, “This will never get any better.” “My pain makes me a bad mom.” “I should be able to muscle through this.” “If I can’t work, I can’t ever let myself do something fun—that would be too indulgent.”

Shine a bright light on your beliefs and ask if they’re really working for you.  Chances are, you’ll find some duds.  Re-calibrate: “I can have an impact on my pain.” “I face more challenges than the average mom, but I’m not bad, plus I set a good example by trying hard.” “I don’t have to power through; I’ll outsmart my pain by pacing.” “Even if I can’t work, doing fun things gives me the energy to keep fighting my pain.”

To wrap up, know you’re not alone: 42 million Americans’ sleep is disturbed by pain more than once a week, 26 million Americans suffer from frequent back pain, and $600 billion dollars annually are either spent by the health care system on chronic pain or lost due to decreased productivity and disability.

In short, if you’re in pain, you’re in good company. And it’s not all in your head. Well, okay, unless it’s a headache, but you get the picture.

What is chronic pain and why is it hard to treat?

A recent study by the National Institutes of Health found that more than one in three people in the United States have experienced pain of some sort in the previous three months. Of these, approximately 50 million suffer from chronic or severe pain.

To put these numbers in perspective, 21 million people have been diagnosed with diabetes, 14 million have cancer (this is all types of cancer combined) and 28 million have been diagnosed with heart disease in the U.S. In this light, the number of pain sufferers is stunning and indicates that it is a major epidemic.

But unlike treatments for diabetes, cancer and heart disease, therapies for pain have not really improved for hundreds of years. Our main therapies are non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, which are just modern versions of chewing on willow bark; and opioids, which are derivatives of opium.

In 2012 259 million prescriptions for opioids were filled in the United States. It is not clear how many of these prescriptions were for chronic pain. And indeed, new CDC guidelines on the use of opioids to treat noncancer chronic pain caution physicians to consider the risks and benefits of using opioids when prescribing them to patients.

The fact is, however, that opioids are used to treat chronic pain not because they are the ideal treatment, but because for some patients, despite their drawbacks, they are the most effective treatment available at the moment.

The problem, as I see it, is this: we are not investing enough in researching and teaching what causes pain and how to treat it.

Pain can have a purpose

I study the processes that trigger and maintain chronic pain. One of the first things I teach my students is that pain is a biological process that is critical for life. Pain protects our bodies from injury and by reminding us that tissue is damaged and needs to be protected it also aids in repairing the injuries we do acquire.

This is graphically illustrated by individuals who are congenitally incapable of feeling pain. People with these conditions typically succumb to infections or organ failure at a young age due to multiple injuries that go unattended. Because they cannot feel pain, they never learn to avoid hazards, or how to protect still-healing injuries.

For the most part, physicians and scientists are not particularly concerned with pain from everyday bumps, bruises and cuts. This type of acute pain typically does not require treatment or can be treated with over-the-counter medication. It will resolve itself when the tissue heals.

What concerns those of us who treat and study pain, however, is chronic pain. This type of pain – that can last for weeks, months or even years – serves no useful purpose for survival and is actually detrimental to our health.

There isn’t one type of chronic pain.

In many cases chronic pain persists after an injury has healed. This happens relatively often with wounded veterans, car accident victims and others who have suffered violent trauma.

Chronic pain from arthritis is telling the person about the damage in their body. In this respect it is similar to acute pain and, presumably, if the body healed the pain would subside. But, at the moment, there is no treatment or intervention to induce that healing so the pain becomes the most troubling aspect of the disease.

Chronic pain can also arise from conditions, like fibromyalgia, which have an unknown cause. These conditions are often misdiagnosed and the pain they produce may be dismissed by health care professionals as psychological or as drug-seeking behavior.

How does the brain process pain? Wellcome Images, CC BY-NC-ND

How do we experience pain?

The human pain experience can be divided into three dimensions: what pain researchers call the sensory-discriminative, the affective-motivational and the cognitive-evaluative. In acute pain there is a balance between each of these dimensions that allows us to accurately evaluate the pain and the threat it may pose to our survival. In chronic pain these dimensions are disrupted.

The sensory-discriminative dimension refers to the actual detection, location and intensity of the pain. This dimension is the result of a direct nerve pathway from the body to the spinal cord and up into the brain’s cortex. This is how we are aware of the location on our bodies of a potential injury and how much damage may be associated with the injury.

Knowing where it hurts is only part of experiencing pain. Is your injury life-threatening? Do you need to run away or fight back? This is where the affective-emotional dimension comes in. It arises from the pain circuitry interacting with the limbic system (the emotional centers of the brain). This adds an emotional flavor to the incoming pain signal and is part of the fight-or-flight response. This pathway evokes the anger or fear associated with the possibility of physical harm. It also provokes learning so that in the future we avoid the circumstances leading to the injury.

The third dimension, the cognitive-evaluative, is the conscious interpretation of the pain signal, combined with other sensory information. This dimension draws on the different aspects of pain processing allowing us to determine the location and potential severity of an injury and to come up with survival strategies based on all available information.

When pain is the disease. Hands images via www.shutterstock.com.

When it always hurts

The pain sensory system is designed for survival. If a pain signal persists, the default programming is that the threat to survival remains an urgent concern. Thus, the goal of the pain system is to get you out of harm’s way by ramping up the intensity and unpleasantness of the pain signal.

To increase the urgency of the pain signal, the sensory-discriminative dimension of pain becomes less distinct, leading to a more diffuse, less localized, pain. This pathway also amplifies the pain signal by rewiring spinal cord circuits that carry the signal to the brain, making the pain feel more intense.

If there is a threat to survival, the increasing intensity and unpleasantness of pain serves a purpose. But if the pain signal persists from, let’s say, arthritis or an old injury, the increased intensity and unpleasantness is unwarranted. This is what we define as chronic pain.

In chronic pain, as compared to acute pain, the affective-motivational dimension becomes dominant, leading to psychological consequences. Thus suffering and depression are much worse for chronic pain patients than it would be for an individual with an equivalent acute injury.

The multifaceted nature of pain is why opioids are often the most effective agents for both moderate to severe acute and chronic pain.

Opioids act at all levels of the pain neural circuitry. They suppress incoming pain signals from the peripheral nerves in the body, but importantly for chronic pain patients, they also inhibit the amplification of the signals in the spinal cord and improve the emotional state of the patient.

Unfortunately, patients rapidly develop tolerance to opioids, which significantly reduces their effectiveness for chronic therapy. Because of this as well as their addictive nature, potential for abuse and overdose, and side effects such as constipation, opioids are less than ideal agents for treating chronic pain. It is critical that we find alternatives. But that’s easier said than done.

Funding for pain research lags

In 2015 the National Institutes of Health spent US$854 million on pain research, compared to more than $6 billion for cancer. It is no wonder that pain patients muddle through with what amounts to centuries-old therapies.

The competition for funding for pain researchers is intense. In fact, many of my friends and colleagues, all highly experienced midcareer scientists, are leaving research because they cannot sustain the funding necessary to make any significant progress in finding treatments for pain. I, myself, spend up to 30 hours per week preparing and writing research proposals for funding agencies. Yet, less than one in 10 of these proposals are funded. The dearth of funding is also discouraging young scientists from doing pain research. With tenure at major universities becoming more and more difficult to attain, they can little afford to spend all of their time writing research proposals that do not get funded.

In addition, many medical and dental programs in the United States devote as little as one hour in their curriculum to teaching pain mechanisms and pain management. Thus, most of our health professionals are poorly prepared to diagnose and treat chronic pain, which contributes to both the under treatment of pain and the abuse of opioids.

Unrelieved pain contributes more to human suffering than any other disease. It is time to invest in research to find safe effective therapies and on training health care providers to appropriately diagnose and treat pain.

16 Things People With Chronic Pain Wanna Tell You

It’s not just in our head. The pain is there and always would be even if there is no apparent reason for it. Our pain is real and will not just go away after we take some pills for a week or two. It would always be there and we have learned to live with it. Here are 16 more things we wish you knew about us!

1. We Don’t Make a Mountain out a of Molehill

You think you can imagine our pain? Now multiply that amount by 10. No matter how sympathetic you are, studies have proved that people tend to underestimate other people’s pain. Chronic pain by default is hard to imagine unless you have experienced it in your life. It’s invisible, but it is always there. We urge health care not out of hypochondria or the need for attention, but because of our severe physical state.

2. We Need to Balance Actions Carefully

We use the Spoon Theory: We have a limited amount of spoons each day we could use for different actions. Getting up, getting dressed, taking a shower, driving, walking, picking up the phone — each action requires us to use one of our precious spoons. On good days, we finish with a few spoons left, so we can do something fun. On bad days, we borrow spoons from the next day and need extra recovery afterwards. So if we suddenly cancel our plans with you or tell we can’t do it now — it’s just because we ran out of spoons today. Try to understand this.

3. We Struggle to Find a Good Doctor

Sadly, a lot of health care pros lack knowledge in pain management because it is rarely part of their training. We often visit numerous specialists before receiving a proper diagnosis and wait months to years to see a real pain specialist for treatment. Doctors often fall victim to the cognitive error of underestimating another’s pain and a small number of doctors are willing to take the legal risks involved in prescribing powerful pain pills.

Same goes with the nurses. Finding a good one who can really understand and help us relieve the pain is hard! Luckily, there are some online schools like Sacred Heart University that are training future nurse leaders to overcome these issues in the future and provide better care for patients.

While you may think it’s crazy, we’re willing to travel further to find a good nurse with this kind of training and rave about it when we find one.

4. We Are Not Lazy

Remember the limited amount of spoons we have? Now add the fact that it takes twice as much effort for us to complete even simple things. We try harder than other folks, yet we still manage to accomplish less.

5. We Try to Look Our Best

“But you don’t look sick” is one of the most common phrases you hear if you have invisible disease. Well yes, we try to look our best even on bad days when our body explodes from pain. We dress up carefully to cover up our bruises or swelling, take painkillers at the optimal time, and rest before going out. We would love to pass as normal as much as possible! Even if we feel pain, we would keep it to ourselves until the moment we step into our apartment and just collapse.

6. We Don’t Ignore You

Sometimes our pain occupies too much space in our brains and we simply cannot focus on anything else. Pain can be very distracting and mentally draining, so please forgive us when we can’t give all the attention to you.

7. We Know Our Illness Won’t Go Away

It’s always there. We can’t escape. And yes, we have researched all the possible options. If there was a cure, we would know about it!

8. We Are Not Drug Seekers

Sadly, we need to explain that both to the doctors and folks around. We don’t want drugs. We want anything to make the pain go away even for a little while. So yes, sometimes our treatment requires taking opioids or medical marijuana. We treat those just like any other remedy. And no, we are not particularly fond of the side effects either.

In fact, as the Cleveland Clinic explains: Addiction appears to be distinctly uncommon in patients without a prior history of addiction. Addiction is a psychological phenomenon that isn’t caused by chemical components of the drugs and typically requires a setting different from the one we have. We take our drugs under supervision and come back home to the loving family unlike the street-users.

9. We Don’t Always Know How to Manage Our Pain

Just because we have been dealing with it for ages doesn’t mean we always know how to tame it. Sometimes, we have very bad days when no previous routines help. We just close our eyes and wish those would pass faster.

10. We Get Super Active on Good Days

Physically feeling good is just about the most exciting feeling we can have! We can do our chores normally, go on a day trip, meet with a bunch of people at a time, and even think of running a marathon. On a good day we are super active and excited with everything, trying to get as much done as possible!

11. We Don’t Want You to Stop Inviting Us Out

No matter how many times we have said “no” we still want to be part of the gang and go out when we really can do it.

12. We Don’t Have a Job for a Reason

Again, we are not lazy. It’s just that we often lack spoons to work on the top of our other activities and daily chores. Besides, most employees refuse to take staff for a few hours per week and tolerate the fact that we can leave at the middle of the day if our pain gets unbearable.

On the bright side though, thanks to technology we can work from home in our own pace, doing various jobs online, selling stuff on eBay or Etsy, learn everything we need from self-help and nursing to design or coding online. If we don’t have a regular job, it doesn’t mean we can accomplish nothing in life. Multiple sclerosis did not stop Vanessa Heywood from creating an award-winning music company!

13. We Don’t Want Sympathy, We Want Acceptance

Instead of making that “I’m so sorry for you” sad face, treat us like equals. It’s not that you should completely ignore our condition, but show us you are ok with it and ready to make small adjustments for us.

14. We Don’t Want Your Medical Advice

Believe me, we have heard enough already and feel frustrated, as they don’t work. Thanks for the thought, but let’s just talk of something else. My disease does not define me. I know a lot of other interesting things, I would love to discuss with you instead.

15. We Need to Know You Are Here for Us

No matter how self-sufficient and independent we try to appear, sometimes we just need you to be here with us and hold our hand on a bad day.

16. We Appreciate You and Everything You Do for Us

You should never forget that. We are eternally grateful for supporting us and making us feel loved!

17 Things Healthy People Need to Hear During Invisible Illness Awareness Week

When a person’s illness isn’t easily visible, it can be difficult for outsiders to grasp the challenges he or she faces. “If you look ‘normal,’” they may say, “you can’t really be that sick.” Nothing could be further from the truth.

As the chronic illness community comes together to support Invisible Illness Awareness Week, which began on September 26, we asked our Mighty community what message they want to share to explain the truth about how invisible illness affects their lives and how their friends, families and acquaintances can better support them. By educating the general population, we can hopefully get closer to acceptance and understanding of the realities of invisible illness.

Here’s what they said:

1. “I appear as I want you to see me. I paint on my ‘I’m OK’ face every morning before school and walk around with a smile, but the truth is that I am in chronic pain, always struggling, but you will never see that because I do not want to appear in that light. You may believe I am faking being sick, but I am actually faking being well, and people need to not be as quick to judge.”

2. “Just because I’m young doesn’t mean I’m not disabled. I have had many older men and women yell at me and point to the handicapped sign and then they realize I have handicapped plates. Just because I’m young, doesn’t mean I’m not struggling. I didn’t realize disability had an age limit… someone should really tell my body that.”

3. “I don’t need you to understand what I go through. I just need you to be a compassionate human being like you would to someone who was fighting an illness you could see. Don’t pity, but be decent.”

4. “Just because you’re tired of hearing about us being sick or in pain doesn’t make us any less sick or in pain. I know you can get desensitized to hearing we’re in pain every day, but we don’t get the luxury of being desensitized to the pain. Please be patient with us, and remember we’re struggling and often smiling through pain.”

5. “If I’m out doing something and smiling, I’m running on adrenaline and it will take me several days to a week to recover.”

6. “My illness may be labeled invisible, but if you look closely you can tell when I’m not doing well. I use a wheelchair, I’m more pale, don’t talk as much, etc. so my illness really isn’t that invisible.”

7. “Though I may have the same illness as your aunt, your friend of a friend, whomever, I’m not going to be the same or healed by random internet advice. Please don’t be Doctor Google unless you’re trying to be supportive and educate yourself.”

8. “Just because an illness or condition isn’t widely known doesn’t make it any less serious than any other illness.”

drawing of little girl looking up with quote just because an illness or condition isnt widely known doesn't make it any less serious than any other illness

9. “This isn’t who I am. My illness does not define me. So even when I am sick, I will pull myself together. I will have a social life. I am determined to live my life to the fullest, sick and all.”

10. “Chronic illness can be lonely. It is easier to make no plans than to cancel plans, especially when friends and family members may not be able to understand. Please don’t give up on a person because their lives are busy with doctors, treatments, and seeking health.”

11. “Just because I can hang out with you seemingly normally for hours doesn’t mean I’m not in pain inside.”

12. “We don’t want unsolicited advice on how to treat our diseases! We don’t care that someone you ‘know’ has or ‘had’ the same thing. Everyone is different. Please keep opinions to yourselves unless specially asked a question.”

13. “My illnesses may be invisible, but I am not. My illnesses may be invisible, but my voice is not. My illnesses may be invisible, but the dreams I once had, the faith I once had, the person I once was — they are not.”

14. “I push myself well beyond what my illness truly should allow me to. I try to be the best wife, mother, coworker, and friend I can be. I probably disappoint myself way more than I do you.”

low battery running with text next to it i push myself well beyond what my illness truly should allow me to

15. “I am not going to get better. I think people have a hard time getting that. For them, they get sick and then a few days or maybe a week later they get better. When you are still sick months, years later, people have trouble with that.”

16. “Ask questions before you judge me. I’m happy to share my story and want to educate others. My pain is real so if you don’t understand get to know me.”

17. “Using the sentence ‘I believe you’ will be one of the most empowering things you can say to someone you care about who is struggling.”

I’m Not Letting My Chronic Pain Stop Me From Becoming a Mom

Becoming a mom is so easy for some people — they get pregnant when they want to and then they pop out a kid. This is how it happened for my best friend, and I’m seriously jealous of her for this. But that’s not how it’s going to happen for me. For the last 10 years, I’ve had a chronic pain condition that is now making the process of getting pregnant so difficult.

I never imagined I would still be struggling with myofascial pain syndrome by the time I felt ready to have a baby. In fact, before this happened to me, I had no idea that 100 million Americans suffer from chronic pain.

I never imagined I would still be struggling with myofascial pain syndrome by the time I felt ready to have a baby.

I was backpacking with friends in Europe the Summer after I graduated college and after a week my back started to hurt — and it never stopped hurting. I was supposed to spend all Summer with my friends galavanting around Europe. Instead, I went home after two weeks and have been in pain ever since. According to my doctors, my pain turned chronic because my body never healed properly after the initial injury from wearing my heavy backpack. It’s as simple and uninteresting as that.

I was in denial for the first few years, always assuming I would get better. I didn’t take care of myself and did my best to ignore the pain. But I was determined to not let it stop me from accomplishing my goals. I was able to get my Masters degree, complete a two-year tour in Paraguay with the Peace Corps, and get married. Despite these accomplishments, I still feel like I have missed out on so much because of my pain. My desire to travel extensively and work overseas in the humanitarian aid industry became an impossible pipe dream.

I constantly cancel plans with friends and don’t make new ones because it’s too difficult to nurture budding relationships. I spend most of my free time just trying to take care of myself — sitting in doctor’s office waiting rooms, doing my exercise routines, standing in line at the pharmacy, and arguing with my insurance company over the phone. My health is my one and only extracurricular activity.

Four years ago I acquired a team of health professionals to finally get my pain stabilized. I was ready to confront this demon head-on and get some control over my life. I had a pain doctor, a therapist, a physical therapist, and a massage therapist. I was on a cocktail of medications and I was starting to feel like I wasn’t the sick girl anymore. My pain was under control, I had a full-time job with sick days to spare, I had a supportive saint of a husband, I attended all of my crazy Jewish family’s events, and I had dinner every week with my 102-year-old grandfather.

I had a good, mostly normal life. I couldn’t do yoga, spend all day at an amusement park, or pick up my 2-year-old nephew when he came to visit, but I had come to terms with my condition and adjusted my life goals.

Now I want a baby. I’m 32 years old, so I don’t have the luxury to not think about it now.

Now I want a baby. I’m 32 years old, so I don’t have the luxury to not think about it now. I consulted with all of my doctors and they agreed I could do it, but that it wasn’t going to be an easy journey. They also concluded that I was in a good mental headspace to handle it, since I had come so far with accepting my fate as a chronic pain princess. I even had coffee with a pregnant woman with a severe chronic pain condition for advice and moral support.

I was ready to begin the business of becoming a mom.

I started by weaning off my meds. It took five long months to get them out of my system. But once I got off the last dose my body wasn’t happy. My pain levels and fatigue increased and my anxiety was through the roof. I went through a terrible withdrawal and felt like I was hungover and drunk all at the same time — I had to take almost a week off work.

Then, the craziest thing happened. I was cleared and ready to start trying for a baby for about two days when I was offered a dream job in my dream town. But, instead of being excited about my dreams coming true, I was a mess. I had to move, find a new place to live, make a good impression at my new job without taking too many sick days, and try to have a baby all while feeling like crap.

It was all too much. The second I made the very tough decision to forgo babymaking and get back on my meds, I felt immediately more at peace. I mourned the loss of my baby plan for a bit, but I was finally able to get excited about my new life changes.

Months later, I’m settled in my new home, and have been kicking ass at my new job. I’m feeling pretty good and hoping to get back on the baby train soon. Before I ever had chronic pain, I knew I wanted to be a mom, just like I knew I wanted to be in the Peace Corps. And I did that while in pain, so I think I can be a mom in pain too, even though the idea makes me incredibly anxious.

I know my baby experience will be different from my best friend’s (she made me her baby’s godmother — so I forgive her!), and maybe it’s a foolish undertaking to try and be a mom while living with chronic pain, but I refuse to let my condition stop me from the experiencing the joy of motherhood.

12 Yoga Poses for Back Pain – Strengthen and Heal Your Lower Back

After making it to the big leagues – aka cubicle life – I noticed a major shift in my overall energy and health. The key driver behind this shift was – drumroll please – sitting.

We all sit.

We sit in our cars.

We sit on our couches.

We sit at work.

We sit while eating.

We sit. We sit. And then we sit some more.

But here’s the scary part. Sitting is leading to a nationwide epidemic. Millions of people suffer from back and neck pain every year with most cases stemming from our modern sedentary lifestyles.

To drive this point home, below are a few factoids on this sitting epidemic:

Sedentary lifestyle contributes to or can be a risk factor for:

  • Organ damage: heart disease, over-productive pancreas, and colon cancer
  • Muscle degeneration: mushy abs, tight hips, limp glutes
  • Leg disorders: poor circulation and soft bones
  • Foggy brain, strained neck, sore shoulders, and back
  • Bad back: inflexible spin and disk damage.

How the back suffers:

The back suffers from the neck down to the tailbone; it’s an all-over crisis. I know ‘crisis’ sounds extreme, but truly, sitting is the new smoking. Let’s examine this a bit deeper:
While sitting at your desk, the neck is strained from the constant craning action towards a keyboard or computer screen. The shoulders are overworked from the constant rounding action of the back, which results in poor posture.

And our spines – aaaaah!

The spine becomes inflexible due to lack of movement and fresh blood pumping through the system. This “lack” then leads to the discs becoming squashed and uneven, eventually leading to hardened collagen in all the wrong places.

So how can we relieve and ultimately reverse the aches and pains from our sedentary lifestyles?

Here’s what professionals recommend:

  • Sit on something wobbly like a stability ball.
  • Stretch the hip flexors often.
  • Alternate between sitting and standing.Take frequent walks.
  • Try doing yoga – duh!

That last bullet point is why I’m writing this article and why you’re here. I love yoga, you love yoga, now let’s use the beautiful practice to heal our bodies and reverse all that damn sitting!

Below are 12 yoga poses to help relieve tension, circulate the blood, create space in the body, and most importantly – help our backs feel young again.

Psst… Want to take the class? Watch the free video tutorial at the bottom of this article.

1. Apanasana

  • Begin lying on your back with legs and arms extended long.
  • Exhale – bring both knees into the chest and clasp your hands around them.
  • Keep the back flat on the mat and draw the tailbone and sacrum toward the ground to lengthen the spine.
  • Release the shoulder blades down and broaden across the collarbone.
  • If comfortable, rock gently from side to side to massage the spine.

Benefits: helps keep the low back long, often used a counter stretch to backbends and spinal twists, and used as an eliminator of waste, toxins, and tension.

Cautions: avoid if recovering from abdominal surgery, hernia, spinal, knee, or hip injury.

apanasana


 

2. Ardha Apanasana

  • Begin lying on your back with legs and arms extended long.
  • Exhale – bring both knees into the chest and clasp your hands around them.
  • Hold the right knee into the chest and extend the left leg long.
  • If comfortable, rock the knee from armpit to chest, then find stillness wherever is comfortable.
  • Keep the back of the neck long and shoulder blades pulled down away from the ears.
  • Stay for a minute, and then switch to the other leg.

Benefits: helps release tension in the lower back, hips, and thighs and aids in stiffness of the spine.

Cautions: avoid this pose if you have spinal injury or sciatica.

Ardha Apanasana


 

3. Supine Spinal Twist

  • Begin from the pose above and with the right knee into the chest.
  • Exhale – roll onto your left hip as the right knee softens toward the ground.
  • Extend your right arm out along the floor, shoulder-width height.
  • Keep the left hand resting gently on the right knee.
  • Let the right knee become heavy, slowly releasing further towards the floor.
  • Stay for 10 – 30 breaths.
  • Inhale – gently engage the low belly and bring both knees back to center.
  • Repeat the above steps on the left side.

Benefits: stretches the back muscles and glutes, massages the back and hips, hydrates the spinal discs, and lengthens, relaxes, and realigns the spine.

Cautions: if back pain or back injury is a concern, bring both knees together and twist to your body’s comfort.
spinal twist

spinal twist 2


 

4. Cat & Cow Pose

  • Begin in a neutral tabletop position – shoulders stacked over wrists, hips over knees, and knees hip-width distance apart.
  • Inhale into Cow pose – belly softens towards the ground, the tailbone lifts skyward, shoulders roll back, collarbone broadens, chin slightly lifts, and the gaze goes toward the ceiling.
  • Exhale into Cat pose – tailbone drops toward the ground, round the back, belly comes up and in, and allow head and neck to completely relax.
  • Repeat this movement 5 – 10 times.

Benefits: strengthens the low back with a lengthened spine, creates stability in the wrists, elbows, shoulders, hips, and knees.

Cautions: for sensitive joints, support the knees by folding the mat or placing a blanket underneath them.

cow pose

cat pose


 

5. Forward Fold

  • Begin in Mountain pose and bring hands to the hips.
  • Exhale – bend the knees and release the entire body towards the ground.
  • Keep a bend in the knees – as deep or mild as you choose.
  • Let the chest, head, and neck completely relax and melt down.
  • Engage the quadriceps to let the hamstrings release.
  • Keep the weight in the balls of your feet and hips stacked over ankles.
  • Inhale – gently feel the torso lift and lengthen.
  • Exhale – release deeper in the posture.

Benefits: increases forward flexion in the spine and hips, calms the brain, relieves stress, headaches, anxiety, fatigue, and insomnia, and deeply stretches the hamstrings and calves.

Cautions: if suffering from back pain or back injury, keep the knees bent and the body soft.

forward fold


 


 

6. Downward Facing Dog

  • Begin in a neutral tabletop position like Cat/Cow pose above.
  • Spread the fingers wide and keep middle or pointer finger directly straight to the front of the mat.
  • Exhale – curl the toes under, lift the knees off the ground, send the hips back and high towards the ceiling, lengthen the arms long, chest melts down towards the thighs, and keep head and neck in-line with the arms.
  • Imagine the body is making a V shape here.
  • Keep the knees bent to allow expansion and relief across the low back.
  • Stay for as long as your heart desires, then exhale the knees back to the ground into a neutral tabletop position.

Benefits: energizes and rejuvenates the entire body, deeply stretches hamstrings, shoulders, calves, hands, and spine.

Cautions: those with severe carpal tunnel syndrome, late-term pregnancy, injury to back, arms, shoulders, high blood pressure, eye or ear infections should avoid or move with caution.

downward facing dog


 

7. Child’s Pose

  • Begin in a neutral tabletop position – bring knees together, sit back onto the heels, then gently release the torso to the ground.
  • The arms can drape behind the body with palms up or extend long towards the front of the mat with palms down.
  • Forehead softly rests on the ground and back of the neck is long.
  • Gently close the eyes and let gravity do the work.

Benefits: helps relax and rejuvenate the entire body, encourages forward flexion in the spine, hips, and knees. Considered a resting pose that centers, calms, and soothes the body.

Cautions: avoid if experiencing knee injury or recovering from a recent knee injury.

child's pose


 

8. Rabbit Pose

  • From the #7 child’s pose, bring hands to the backs of the heels and pull the forehead in towards the knees with the top of your head resting on the floor.
  • Inhale – lift the hips towards the ceiling, roll onto the crown of the head, and press forehead as close to the knees as possible.
  • Hold for 5 – 10 deep breaths.
  • Exhale – lower the hips to the heels and slide forehead forward, resume child’s pose.

Benefits: allows maximum flexion in the spine and lengthens and stretches the back, arms, and shoulders.

Cautions: avoid if recent or chronic injury to the knees, neck, spine or shoulders and place a blanket under knees or neck to protect from pressure.

rabbit pose


 

9. Thread the Needle

  • Begin in neutral tabletop position and start on the right side.
  • Inhale – send the right hand straight up to the sky and open through the heart.
  • Exhale – thread the right hand through and underneath the left arm with the palm facing up.
  • Let the right shoulder and ear relax down to the ground.
  • Keep the left hand planted, extend it long in front of you, or wrap it around the opposite hip for a bind.
  • Soften, relax, and melt into the posture here – let all tension release.
  • To come out – press into the left hand, slide the right arm out from underneath, and return to tabletop position.
  • Repeat the steps on the left side.

Benefits: stretches and opens the shoulders, chest, arms, upper back, and neck, releases tensions held in the upper back and between the shoulder blades, and provides a gentle twist to the spine which further reduces tension.

Cautions: avoid if you have recent or chronic injury to knees, shoulders, or neck and practice with caution for those with back pain, back injuries, or disc complications.

thread the needle


 


 

10. Pigeon Pose

  • Begin in a neutral tabletop position – bring right knee to right wrist and right ankle towards the left wrist.
  • Extend the left leg back with the kneecap and top of the foot resting on the floor.
  • Inhale – press fingertips into the ground and lift/ lengthen through the front side of the body.
  • Exhale – release the torso to the ground, a block, or forearms.
  • Focus on keeping the hips squared to the front of the mat.
  • Hold the pose for up to a minute while breathing deeply into the body.

Benefits: deeply stretches the upper-leg and hip muscles – psoas, piriformis, and gluteus maximus.

Cautions: avoid if you have recent or chronic knee, ankle, or back injury – instead do a modified figure 4 version on the back.

pigeon pose


 

11. Happy Baby

  • Begin lying on your back with knees drawn into the chest.
  • Grab hold of the outer foot with your hand and keep arms in front of the shins.
  • Flex the feet and engage the arms.
  • Bring the knees wide and toward the armpits and stack ankles over knees.
  • Use your arm strength to bring the knees closer to the ground and release the lower back into the mat.
  • Stay for as long as you like, rock gently from side to side, and breathe.

Benefits: opens and stretches the hips, stretches the inner groin, lengthens and helps realign the spine, calms the mind and relieves stress, strengthens the arms and shoulders.

Cautions: knee or ankle injuries, extremely tight hips, and those who are pregnant should practice with caution.

happy baby


 

12. Legs Up the Wall

  • Find a wall with plenty of space to stretch alongside it.
  • The sitting bones should be pressed against the wall or a few inches away, back and head are resting on the ground, and legs are straight up with the knees soft.
  • Take a moment to adjust the body and find what works best for you. Feel free to incorporate bolsters and blankets for added comfort.
  • Completely relax into the posture – let the entire body melt, soften, and surrender to the ground beneath you.
  • Stay here for as long as your heart desires!

Benefits: eases anxiety and stress, gently stretches the hamstrings, legs, and lower back, helps with low back pain, and calms the mind.

Cautions: this a mild and restorative posture but still considered an inversion with feet above the heart – avoid if menstruating, pregnant, high blood pressure, or glaucoma.

yogi-approved---back-relief-sequence---10739


 

*These yoga postures are a general guideline to help with back pain and can be performed in any specific order. I’ve listed them in the order that makes sense for my personal practice. Always listen to your body, breathe deeply into the posture, and back out if any pain arises.

The above yoga postures barely scratch the surface of how yoga can heal and restore the body, especially for those who suffer from back pain. I highly recommend seeking out a yoga workshop, a private yoga lesson, or a yoga therapist to learn more about your body and how yoga can help.

While doing the above postures, please listen to your body – wholeheartedly – and know when to back out or go deeper. You are your own best teacher!

The chronic pain epidemic: 50 million Americans live in agony.. but what is chronic pain and why is it so hard to treat?

A recent study by the National Institutes of Health found that more than one in three people in the United States have experienced pain of some sort in the previous three months.

Of these, approximately 50 million suffer from chronic or severe pain.

To put these numbers in perspective, 21 million people have been diagnosed with diabetes, 14 million have cancer – this is all types of cancer combined – and 28 million have been diagnosed with heart disease in the US.

In this light, the number of pain sufferers is stunning and indicates that it is a major epidemic.

But unlike treatments for diabetes, cancer and heart disease, therapies for pain have not really improved for hundreds of years.

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Approximately 50 million people suffer from chronic or severe pain in the US, according to the National Institutes of Health

Approximately 50 million people suffer from chronic or severe pain in the US, according to the National Institutes of Health

Our main therapies are non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, which are just modern versions of chewing on willow bark; and opioids, which are derivatives of opium.

In 2012, 259 million prescriptions for opioids were filled in the United States.

It is not clear how many of these prescriptions were for chronic pain.

And indeed, new CDC guidelines on the use of opioids to treat noncancer chronic pain caution physicians to consider the risks and benefits of using opioids when prescribing them to patients.

The fact is, however, that opioids are used to treat chronic pain not because they are the ideal treatment, but because for some patients, despite their drawbacks, they are the most effective treatment available at the moment.

The problem, as I see it, is this: we are not investing enough in researching and teaching what causes pain and how to treat it.

Pain can have a purpose

I study the processes that trigger and maintain chronic pain.

One of the first things I teach my students is that pain is a biological process that is critical for life.

Pain protects our bodies from injury and by reminding us that tissue is damaged and needs to be protected it also aids in repairing the injuries we do acquire.

This is graphically illustrated by individuals who are congenitally incapable of feeling pain.

People with these conditions typically succumb to infections or organ failure at a young age due to multiple injuries that go unattended.

Because they cannot feel pain, they never learn to avoid hazards, or how to protect still-healing injuries.

For the most part, physicians and scientists are not particularly concerned with pain from everyday bumps, bruises and cuts.

In most cases chronic pain persists after an injury has healed, with wounded veterans, for example, car accident victims and others who have suffered violent trauma. Furthermore, chronic conditions such as arthritis, pictured, is the body's way of telling you the damage that is being caused 

In most cases chronic pain persists after an injury has healed, with wounded veterans, for example, car accident victims and others who have suffered violent trauma. Furthermore, chronic conditions such as arthritis, pictured, is the body’s way of telling you the damage that is being caused

This type of acute pain typically does not require treatment or can be treated with over-the-counter medication. It will resolve itself when the tissue heals.

What concerns those of us who treat and study pain, however, is chronic pain.

This type of pain – that can last for weeks, months or even years – serves no useful purpose for survival and is actually detrimental to our health.

In many cases chronic pain persists after an injury has healed. This happens relatively often with wounded veterans, car accident victims and others who have suffered violent trauma

There isn’t one type of chronic pain.

In many cases chronic pain persists after an injury has healed.

This happens relatively often with wounded veterans, car accident victims and others who have suffered violent trauma.

Chronic pain from arthritis is telling the person about the damage in their body.

In this respect it is similar to acute pain and, presumably, if the body healed the pain would subside.

But, at the moment, there is no treatment or intervention to induce that healing so the pain becomes the most troubling aspect of the disease.

Chronic pain can also arise from conditions, like fibromyalgia, which have an unknown cause.

These conditions are often misdiagnosed and the pain they produce may be dismissed by health care professionals as psychological or as drug-seeking behavior.

How do we experience pain?

The human pain experience can be divided into three dimensions: what pain researchers call the sensory-discriminative, the affective-motivational and the cognitive-evaluative.

In acute pain there is a balance between each of these dimensions that allows us to accurately evaluate the pain and the threat it may pose to our survival. In chronic pain these dimensions are disrupted.

The sensory-discriminative dimension refers to the actual detection, location and intensity of the pain.

This dimension is the result of a direct nerve pathway from the body to the spinal cord and up into the brain’s cortex.

This is how we are aware of the location on our bodies of a potential injury and how much damage may be associated with the injury.

One element of pain is know as the sensory-discriminatove dimension and refers to the actual detection of pain - the direct result of a nerve pathway from the body to the spinal cord and up to the brain's cortex

One element of pain is know as the sensory-discriminatove dimension and refers to the actual detection of pain – the direct result of a nerve pathway from the body to the spinal cord and up to the brain’s cortex

Knowing where it hurts is only part of experiencing pain. Is your injury life-threatening? Do you need to run away or fight back?

This is where the affective-emotional dimension comes in.

It arises from the pain circuitry interacting with the limbic system (the emotional centers of the brain).

This adds an emotional flavor to the incoming pain signal and is part of the fight-or-flight response.

This pathway evokes the anger or fear associated with the possibility of physical harm. It also provokes learning so that in the future we avoid the circumstances leading to the injury.

The third dimension, the cognitive-evaluative, is the conscious interpretation of the pain signal, combined with other sensory information.

This dimension draws on the different aspects of pain processing allowing us to determine the location and potential severity of an injury and to come up with survival strategies based on all available information.

When it always hurts

The pain sensory system is designed for survival. If a pain signal persists, the default programming is that the threat to survival remains an urgent concern.

Thus, the goal of the pain system is to get you out of harm’s way by ramping up the intensity and unpleasantness of the pain signal.

To increase the urgency of the pain signal, the sensory-discriminative dimension of pain becomes less distinct, leading to a more diffuse, less localized, pain.

This pathway also amplifies the pain signal by rewiring spinal cord circuits that carry the signal to the brain, making the pain feel more intense.

If there is a threat to survival, the increasing intensity and unpleasantness of pain serves a purpose.

But if the pain signal persists from, let’s say, arthritis or an old injury, the increased intensity and unpleasantness is unwarranted. This is what we define as chronic pain.

In chronic pain, as compared to acute pain, the affective-motivational dimension becomes dominant, leading to psychological consequences.

In many cases patients living with chronic pain will be prescribed opioid painkillers. Unfortunately it is common for people to rapidly develop a tolerance to these drugs, which significantly reduces their effectiveness

In many cases patients living with chronic pain will be prescribed opioid painkillers. Unfortunately it is common for people to rapidly develop a tolerance to these drugs, which significantly reduces their effectiveness

Thus suffering and depression are much worse for chronic pain patients than it would be for an individual with an equivalent acute injury.

The multifaceted nature of pain is why opioids are often the most effective agents for both moderate to severe acute and chronic pain.

Opioids act at all levels of the pain neural circuitry. They suppress incoming pain signals from the peripheral nerves in the body, but importantly for chronic pain patients, they also inhibit the amplification of the signals in the spinal cord and improve the emotional state of the patient.

Unfortunately, patients rapidly develop tolerance to opioids, which significantly reduces their effectiveness for chronic therapy.

Because of this as well as their addictive nature, potential for abuse and overdose, and side effects such as constipation, opioids are less than ideal agents for treating chronic pain.

It is critical that we find alternatives. But that’s easier said than done.

Funding for pain research lags

In 2015 the National Institutes of Health spent $854 million on pain research, compared to more than $6 billion for cancer.

It is no wonder that pain patients muddle through with what amounts to centuries-old therapies.

The competition for funding for pain researchers is intense. In fact, many of my friends and colleagues, all highly experienced midcareer scientists, are leaving research because they cannot sustain the funding necessary to make any significant progress in finding treatments for pain.

I, myself, spend up to 30 hours per week preparing and writing research proposals for funding agencies.

Yet, less than one in 10 of these proposals are funded. The dearth of funding is also discouraging young scientists from doing pain research.

With tenure at major universities becoming more and more difficult to attain, they can little afford to spend all of their time writing research proposals that do not get funded.

In addition, many medical and dental programs in the United States devote as little as one hour in their curriculum to teaching pain mechanisms and pain management.

Thus, most of our health professionals are poorly prepared to diagnose and treat chronic pain, which contributes to both the under treatment of pain and the abuse of opioids.

Unrelieved pain contributes more to human suffering than any other disease.

It is time to invest in research to find safe effective therapies and on training health care providers to appropriately diagnose and treat pain.

What is chronic pain? Thought-provoking awareness video

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