The Search for a Unique Solution to Chronic Pain

The Precision Medicine Initiative is an ambitious new plan announced by President Obama to find more precise treatments for various illnesses, in part by leveraging recent advances in genetic science. The idea is to do away with “one-size-fits-all” medicine not only through genotyping but also by using existing large datasets that already containing a wealth of patient- and condition-specific information. The details – not to mention the funding by the U.S. Congress – are still uncertain. But precision medicine, if done right, could transform medicine and patient care, particularly for the millions of Americans who experience chronic pain.

Pain affects more than one-third of all Americans and costs more than $600 billions dollars annually, according to the Institute of Medicine. Treatments are marginal, and many patients continue to suffer serious disability and disruption to their lives.  Opioids have been increasingly prescribed, but they are not very effective for many common types of pain, including migraine, low-back pain and neuropathic pain and can be dangerous in the wrong hands. Besides, opioids do not work equally well for all people, and genetic factors are a large reason why.

Pain needs an individual approach with precise treatments as much as or more than any other area of medicine due to the tremendous genetically influenced variability in how people feel pain and how they respond to pain-relieving medications. The same pain stimulus from the same origin can produce wide differences in how much pain is felt, how frequently the pain is felt, how long it lasts and whether prescribed medications work or not.

Some pain disorders are known to have significant hereditary contribution like low-back pain, lumbar disc degeneration, osteoarthritis and temporal mandibular disease.  Migraines, interstitial cystitis and irritable bowel syndrome appear to have similar contributing genes.

Genetic variations can also affect the severity and chronicity of pain, as recent work with the HCN2 gene indicates. There are “pain-reducing” genes and “pain-enhancing” genes.  There are also genes that help make the same drug effective for one person and intolerable — if not toxic — for another person.

Sensitivity to pain also varies. Women experience more pain than men.  Some ethnicities experience more pain than others.

Precision medicine would mean tailoring the treatment to the patient and the disease. This would include genetic testing of the sort French researchers used to quickly determine which patients are among the 5-10% who will not respond to tramadol because they are “poor metabolizers.” Genetic testing may inform clinical decision-making on the best therapeutic options and predict outcomes.  This can lead to improved care, fewer adverse effects and lower cost.

Drug development is where precision medicine could be transformative.  Most drugs have been developed for the average person.  However, there are no average people, only individual responses. Yes, our genes are operative, but our environments also influence what works for us. Genetic research is complex, and clinically relevant findings will take time and commitment. The goal should be finding the best treatment for an individual rather then developing a drug that works only partly well for most people and not at all for others.

But first Congress must fund the bill. If you live with ongoing pain or know someone who does, contact the representative for your congressional district and urge passage of this initiative. In addition to calling for precision treatments, urge that funds also be used to help find cures for persistent pain syndromes.

Finally, seriously consider volunteering to be part of the database proposed in the legislation.  Only by studying large numbers of people with a variety of pain conditions can we identify target genes for further action.  People in pain can and should participate in finding better treatments and, eventually, cures.

11 thoughts on “The Search for a Unique Solution to Chronic Pain

  1. My Daughter and I both suffer from so many different things and I believe they are inherited, Because my parents and Grandparent had the same symptoms. But back then they didn’t have the test they have today. We need more medicines made available for what works for one doesn’t work for the other. Lower back pain, deterioration of the lower back bone, anxiety, Fibromyalgia, Arthritis, bipolar, muscles spasm, IBS, Heart, trouble. High cholesterol, Just a few in my family some I can’t come to spell or pronounce. But yes we need funding made available for this. Soon as possible and no need for them in the White House to drag around with this. I worked 52 years on public jobs, besides the farming before old enough to get public job. Still worked on farm during the public jobs. So I know we paid our share in.

  2. I have the genetically-effected kind of pain cause of ankylosing spondylitis so I’m autoimmune– would I still be a candidate for this study???

  3. i have suffered with fibromyalgia for several years, a few before diagnosis a couple with no pain medications until one day I called my Dr. Screaming in pain and crying after reading on the Internet that Ultram or opids could also be used to try to control the pain and he had only given me several of the supposed “Fibro” drugs, all did not work for me and all gave me unwanted side effects. Last year I was diagnosed with Medullary Thyroid Cancer and had to had a Total Neck Dissection and a Thyroidectomy and since that surgery I’ve been in constant pain and under the care of Pain Management trying to find something to control my neck pain 8 months post-op and still in chronic pain and have not been successful I have tried a TENS unit, Accupunture, Physical Therapy, Massage Therapy, and a few combination Pain medications and compound creams. Not everyone can fit into the little box the doctors try to put you in and then they make you look crazy because their treatment didn’t work. I hope this passes congress and opens up new possibilities for all of those suffering chronic pain and from Dr.’s who want to fit us round pegs into the square holes.

  4. I have been suffering with RSD/CRPS for 7 years. I am yet to find a doctor who can help me. How do I find out more about volunteering? Thank you!

  5. I am a chronic pain sufferer, low back pain that persists after 2 separate back surgeries. I have a spinal cord simulator in to try to block the pain signals to my brain, and a pain pump also trying to limit my pain. I continue to have pain constantly when I get up to walk. I can do some housework, but 10 minutes is about all I can do. My life is very limited and it takes everything I can do just to get up and go to my doctors appointments etc. Limited amount of social activities, mostly sit and watch TV. I am praying for something new to try, just to give me a little more activity.

  6. As a chronic pain sufferer for the last 8 years, I wholeheartedly agree. We are all different. Our pain is different. How we interpret our pain is different. Also, how different drugs work differently on different people. With the number of people suffering in chronic pain in this country, we really need to be actively working on better solutions. Also, to stop judging us for having an invisible illness, and being desperate for some relief. Any relief! No one else gets hassled like us for being sick & needing medication to function. If only there were a test that could show our doctors the level of pain we live with each day……I think the world would be shocked.

  7. Since 1996, I have been dealing with RSD; now known as CRPS. In 2005/6 I was working a concert as a security guard and had a DVT, Staph infection and had been bit by a brown recluse spider. The pain was so bad, I was telling the surgeon to just take my leg. The physical therapist was a 400lb man trying to release my heal cords so I would walk again. No such luck. However, the pain increased and I was put on painkillers which I became addicted. I learned to walk again only to start having severe migraines (I heredited from my grandmother) and was in an extremely bad car accident in 2009. Again, I was told I would never walk again and now I had neuropathy in my left foot. In addition, I had to have my hip replaced and a rod put in my leg. In addition I suffer from severe fibromyalgia and every 6 weeks have steroid injections in my neck, trapezius, scapula and other areas usually with a total of nothing less than 30 but not more than 63. I have a multitude of pills I rely on to keep me functioning. Lyrica w/conjunction of injections help the fibromyalgia pain, but it never goes away. I have been prescribed every drug under the sun as far as pain meds; however, being a red head poses many issues for Dr.’s who are not aware that being a redhead causes issues with Antheshia and pain control. I have Ultram but it doesn’t help much. I am allergic to Tylenol so that takes things such as Percocet or Vicodin off the table. I also have hypothyroidism (paternal side) so my case is extremely complex. As I try and explain to new physicians to my panel; I don’t fall under the normal protocol for treatment, they look at me as if I’m just a frequent flyer. Unfortunately, it’s quite the opposite. I have put on so much weight due to the steroids every 6 months, my normal weight should be not more than 125lbs. Im currently 175 and considered obese. Thank you for your time. If you would like more information, please do not hesitate to contact me. Anything in the name of science.

    Respectfully,
    Wendy Webster

  8. I have post laminectomy syndrome,peripheral neuropathy,interstitial cystitis, sciatica,dysautonomia and am in constant pain.

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