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Chronic pain affects billions of people. It’s time for a revolution.

Chronic pain affects billions of people. It’s time for a revolution.

To overcome this, a major HEAL-funded project is focusing on studying the nervous systems of people with chronic pain more directly, including by restoring faulty dorsal root ganglia and trigeminal nerves from patients undergoing surgery for chronic pain and from cadaver donors. These samples are then cultured and examined using a variety of new technologies – such as proteomics, spatial transcriptomics and metabolomics – to determine how they differ from normal tissue. The goal, Gereau explained, is to figure out what changes occur at the cellular level when pain becomes chronic and to create an atlas of these mechanisms and variations. Understanding this, he added, would ultimately open the door to precision medicine, in which drugs could be designed to specifically target these changes rather than simply relieving pain with anti-inflammatories or opioids.

“In the beginning, everyone thought they would find this one breakthrough painkiller that would replace opioids,” Gereau said. However, it increasingly appears that chronic pain such as cancer may have a number of genetic and cellular causes, which can vary depending on both the disease and the particular constitution of the affected person. “We are learning that pain is not just one thing,” Gereau added. “There are a thousand different things that are all called ‘pain’.”

Also for patients The landscape of chronic pain is extremely diverse. Some people suffer from lower back pain for a year, only for it to disappear again for no apparent reason. Others aren’t so lucky. A friend of a friend suffered from extreme pain in his arm and face for five years after an argument with his son. He had to stop working, couldn’t drive, couldn’t even ride in a car without a neck brace. His doctors prescribed endless medications: the maximum dose of gabapentin, plus duloxetine and others. At some point he was admitted to a psychiatric hospital because his pain was so severe that he was suicidal. There he met other people who were also suicidal after living in terrible pain day after day for years.

The thing that makes chronic pain so terrible is that it is chronic: an excruciating pain that never ends. For people in extreme pain, this is easy to understand. But even less severe cases can be miserable. A pain rating of 3 or 4 out of 10 sounds mild, but having it almost constantly is exhausting—and limiting. Unlike a broken arm, which gets better, or tendonitis, which hurts mostly in response to overuse, chronic pain shrinks your entire world. It’s harder to work, exercise, and even do the many smaller things that make life rich and enriching.

It’s also lonely. When my arms first started acting up, I could barely function. But even after the worst was over, I rarely saw friends; I still couldn’t drive or sit comfortably in a chair for more than a few minutes and felt guilty inviting people over when there was nothing to do. As Christin Veasley, director and co-founder of the Chronic Pain Research Alliance, puts it: “With acute pain and medication, taking it gets you over the hump and you’re on your way.” What people don’t know is , that with chronic pain you rarely feel the same again, even if you also take medication. At best they can relieve your pain, but most of the time they cannot eliminate it.”

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