Chronic pain has been reported to be the most costly health problem in United States. Increased medical expenses, lost income, lost productivity, compensation payments, and legal charges are some of the negative economic consequences of chronic pain. In addition, chronic pain is increasing among all age groups, including children and teens. A study published on July 1 in the journal Pediatrics reported that the number of teens and children in the US who suffer from chronic pain has significantly increased.
Researchers at the Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress at UCLA have addressed this problem. On October 16, they announced that they were serving as the main hub of their new Pain and Interoception Imaging Network (PAIN), which will become a standardized database for brain imaging associated with chronic pain. To date, 14 institutions in North America and Europe are participating. Examples of chronic pain conditions are migraine, irritable bowel syndrome (IBS), fibromyalgia, and rheumatoid arthritis. The PAIN database will comprise hundreds of brain scans and other key clinical information that should help researchers determine similarities and differences between the aforementioned conditions and many other chronic-pain conditions. The researchers claim that the database should accelerate research and treatment development for all types of chronic pain conditions.
“We are now recognizing that chronic pain is a brain disease, and if we want to treat it more effectively, we need to better understand and treat the mechanisms in the brain that are driving it,” explained Dr. Emeran Mayer, a professor of medicine at the David Geffen School of Medicine at UCLA and executive director of the Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress at UCLA. He notes that brain imaging is one of the most promising technologies for breakthrough findings in chronic pain. At present, however, research is extremely limited because of limited funding at most institutions as well as lack of access to large samples of patients. The PAIN database will change that situation; it has the goal of including brain information on more than a thousand patients of all ages.
The database will not only include brain scan data but also metadata (data about data), which will contain clinical and biological information on the patients, such as information on symptom measures, psychosocial factors, gene expression, immune system information, data on intestinal bacteria, and environmental data. Researchers can then develop large, overlapping data sets to pinpoint similarities and differences among chronic-pain conditions and correlate brain scans with clinical metadata. “Like a fingerprint, researchers will be able to pick out distinct patterns from the scans of individuals with each pain condition and, combined with additional information provided by the network, assess how chronic pain manifests differently between men and women, across the life span, or between conditions,” explained Dr. Bruce Naliboff, a professor in the departments of medicine and psychiatry and biobehavioral sciences at the Geffen School of Medicine and co-director of the Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress.
The PAIN database will continue to evolve. In the future, it will also include information about the tens of trillions of microbes that make up the bacteria living in the intestines. It is known that each patient’s gut microbiota is unique, like a signature card. Dr. Kirsten Tillisch, a UCLA associate professor of digestive diseases who directs the neuroimaging core at the Oppenheimer Center, explained, “Researchers are now exploring the connection between the brain and gut, and the type of bacteria living in the intestine may also play a role in some forms of chronic visceral pain.”
Pain is an unpleasant sensation that lets one know that something may be wrong. It is one of the body’s warning signals that indicates a problem that needs attention. Pain starts in receptor nerve cells located beneath the skin and in organs throughout the body. When there is an illness, injury, or other type of problem, these receptor cells send messages along nerve pathways to the spinal cord, which then carries the message to the brain. Pain medications work by reducing or blocking these messages before they reach the brain.
Pain can be anything from a slight nuisance, such as a mild headache, to something excruciating and emergent, such as the chest pain that accompanies a heart attack, or pain of kidney stones. Pain can be acute, meaning new, subacute, lasting for a few weeks or months, and chronic, when it lasts for more than three months. Chronic pain is long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis. Chronic pain may be intermittent or continuous. It may affect people to the point that they cannot work, eat properly, participate in physical activity, or enjoy life.
Low back pain is a major health problem. Back pain is the most frequent cause of activity limitation in people younger than 45 years of age. Cancer pain affects the majority of patients in intermediate or advanced stages of cancer. Arthritis pain affects nearly 50 million Americans each year. Headaches, according to the National Institute of Neurological Disorders and Stroke, affect millions of U.S. adults. The three most common types of chronic headaches are migraines, cluster headaches, and tension headaches.
Other pain disorders such as the neuralgias and neuropathies that affect nerves throughout the body, pain due to damage to the central nervous system (the brain and spinal cord), as well as pain where no physical cause can be found––psychogenic pain––increase the total number of reported cases. When pain becomes such a problem that it interferes with life’s work and normal activities, a person may become the victim of a vicious cycle. Pain may cause a person to become preoccupied with the pain, depressed, and irritable. Depression and irritability often leads to insomnia and weariness, leading to more irritability, depression, and pain. This state is called the “terrible triad” of suffering, sleeplessness, and sadness. The urge to stop the pain can make some people drug-dependent, and may drive others to have repeated surgeries, or resort to questionable treatments. The situation can often be as hard on the family as it is on the person suffering with the pain.
Chronic pain involves all aspects of a person’s life; therefore, the most effective treatment includes not only relief of symptoms, but also other types of support. A multidisciplinary approach to pain management can often provide the needed interventions to help manage the pain. Pain management programs are usually conducted on an outpatient basis. Many skilled professionals are part of the pain management rehabilitation team, including any or all of the following: neurologists/neurosurgeons; orthopedists/orthopedic surgeons; anesthesiologists; oncologists; physiatrists; nurses; physical therapists; occupational therapists; psychologists/psychiatrists; social workers; case managers; and vocational counselors. Special pain programs are located in many hospitals, rehabilitation facilities, and pain clinics.