Pain Awareness Month – where are we now?

September has been ‘Pain Awareness month’ with numerous articles and stories from those who live with chronic pain every day. The western world has seen a rise in chronic pain over recent years, and the number of sufferers is increasing. Is this simply due to pain being under the spotlight with previous generations suffering silently or are our lifestyles making us more likely to suffer from pain, often without obvious cause? 

Increased prescriptions of opioid medications have until recently been seen as a quick fix which has led to widespread misuse and reliance without treating the underlying condition. This has been turned on its head by the NICE guidelines (2021) which recommend a holistic approach to the treatment of pain.

Recent developments 

The American Neurosurgeon, Dr Sanjay Gupta states that as all pain occurs in the brain, this is where treatment should commence. As we know too well chronic pain is often linked with depression, anxiety, poor sleep, loneliness and a host of demographic factors. Dr Gupta is in complete agreement with the NICE guidelines recommending lifestyle changes including an anti-inflammatory diet, using movement as medicine, meditation and prioritising sleep (an issue for many).   

Acupuncture 

The NICE guidelines referred to acupuncture as a recommended treatment for pain conditions.  

Recent research has found a single course of treatment can bring benefits that last for a year. This has been trialled in older adults with long term lower back symptoms, with the two ‘acupuncture’ trial groups benefitting from improvements in back pain disability scores with symptoms improving by at least 30%). There was no marked improvement in those provided with traditional care in the form of medication.  

Genetics? 

A paper in Nature from Oxford researchers from the Nuffield Department of Clinical Neurosciences and the Department of Biochemistry has identified a genetic link to pain. This exists in the structure of the molecular transporter that the gene encodes and links its function to pain. This research offers the potential for specific targeted treatment and the development of a drug to alleviate chronic pain. In many chronic pain conditions, the nociceptors (the nerve cells detecting tissue injury) are overactive with too many signals being sent to the brain which causes more distress. Theories discussing this until now have been unproven. With a new link between membrane transport and chronic pain, there should be deeper understanding of how metabolism and pain are connected in the human body according to Professor Simon Newstead. If medicine (which does not take the form of strong opioids) can be developed to specifically deal with particular areas, this will be a game changer.   

This is promising yet targeted medication may be some years away. In the meantime, the research concludes that those with chronic pain should consider a holistic approach with targeted treatment, active work outs, gym attendance, a good diet - and a course of acupuncture!