Chronic Pain Is a Hidden Epidemic. It’s Time for a Revolution.
Altogether, according to a 2011 Institute of Medicine report, roughly 100 million Americans, almost one-third of the U.S. population, have chronic pain, more than have diabetes, heart disease and cancer combined. Globally, some studies put the number at two billion.
Despite this, the study of pain has long been neglected. The National Institutes of Health has no center devoted to pain, and for decades, pain research received only a fraction of the funding that went to the study of illnesses like heart disease and diabetes. One reason for this, paradoxically, is that pain is a part of so many different conditions. “It touches on cancer, it touches on neurodegeneration, it touches on diabetes, it touches on biomechanics and injury, it touches on mental health,” says Robert Gereau, who directs the Washington University Pain Center in St. Louis. “Because it’s everywhere, it’s sort of nowhere.”
As a result, our understanding of pain, and especially chronic pain, is far behind where it should be. We don’t know what causes a person with an injury to develop chronic pain, or why it happens in some people and not others, or why it happens more often in women. At a genetic and cellular level, we don’t know which systems get out of whack, or why, or how to fix them.
It took the opioid epidemic to make government agencies finally recognize the scale of the problem, and the fact that millions of people with chronic pain had frighteningly few options. Until recently, it had been two decades since a new drug — one that wasn’t an opioid — was approved for treating pain. The aftermath of the epidemic caused other problems: Doctors increasingly suspected pain patients of feigning symptoms to get drugs, leaving some people with chronic conditions scrambling for effective treatments. And the lack of alternatives escalated a longstanding sense of frustration and despair. “The truth is that we’ve failed people in pain,” one clinician admitted. “If we had invested in understanding this years ago, we might have been able to prevent a lot of suffering.”
Now that may finally be changing. In 2018, the National Institutes of Health started the $3.9 billion HEAL initiative: a major effort focused on addressing the opioid crisis and figuring out the underlying mechanisms of pain in order to develop more precise, sophisticated and personalized treatments. Allan Basbaum, who oversees a pain research lab at the University of California, San Francisco, made an analogy to recent breakthroughs in cancer research. For decades, cancer treatment focused on where a tumor was located: liver, stomach, lung. But when researchers were finally able to study those tumors at a genetic and cellular level, that insight led to far more targeted and individualized treatments
“Pain research today is where cancer research was 20 years ago,” Basbaum told me. “The good news is that we’re able to move so much faster now.” Scientists are already closing in on one biological mechanism with the potential to significantly lessen pain, and a number of other approaches are being explored. But the real revolution may be a new understanding of pain’s complexity, an illumination of its hidden workings. One big reason chronic pain has been undertreated and shrugged off for decades is that medicine tends to trivialize conditions it lacks the tools to explain. The chronic-pain revolution we need is one that won’t end until we really understand why millions of people are suffering — and how to offer them meaningful relief.
Chronic pain has traditionally been seen as a symptom: we die in pain, we don’t die of pain. Now researchers are recognizing that chronic pain can be a disease in its own right: a disorder that happens when the nerves in our body — either peripheral ones, like those in our limbs, or central ones, like those running from our spinal cord to our brain — become hyperactive, or “sensitized.”
Chronic Pain Afflicts Billions of People. It’s Time for a Revolution. - The New York Times