Image: Gerald Slota
In Brief
- Chronic pain that persists after an injury heals is often caused by overly excited pain-sensing neurons that signal without an external stimulus.
- Traditional pain drugs that target neural cells directly rarely quiet these abnormal pain messages because the neurons’ heightened sensitivity is driven by a different type of cell called glia.
- Such cells monitor the activity of neurons and attempt to keep them healthy and functioning efficiently. But well-intentioned glial reactions to intense pain can at times prolong that pain.
Helen’s left foot slipped off the clutch on impact, twisting her ankle against the car’s floorboard. It felt like a minor sprain at the time, she recalls, but the pain never subsided. Instead it intensified. Eventually, the slightest touch, even the gentle brush of bed linen, shot electric flames up her leg. “I was in so much pain I could not speak, yet inside I was screaming,” wrote the young Englishwoman in an online journal of the mysterious condi-tion that would torment her for the next three years.
The chronic pain suffered by people like Helen is different from the warning slap of acute pain. Acute pain is the body’s most alarming, intense sensation, whose purpose is to stop us from further injuring ourselves. This type of pain is also called pathological pain because an external cause, such as tissue damage, produces the signals that travel the nervous system to the brain, where they are perceived as pain. But imagine if the gut-wrenching agony of a real injury never stopped, even after the wound healed, or if everyday sensations became excruciating: “I was unable to shower ... the water felt like daggers,” Helen remembers. “The vibrations in a car, someone walking across floorboards, people talking, a gentle breeze … would set off the uncontrollable pain. Common painkillers ... even morphine had no effect. It was like my mind was playing tricks on me.”
This article was originally published with the title New Culprits in Chronic Pain.
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23 Comments
Add CommentI have a herniated disc in C 6 and 7 of my spine. I suffered for three or four years and tried several remedies (pain shot, physical therapy, massage, chiropractor) in an attempt to avoid an expensive and dangerous surgical procedure.
Reply | Report Abuse | Link to thisA co-worker suggested acupunture. Sure enough, after 5 treatments which cost a total of $325, the pain left and I haven't had pain for 5 years and counting.
How does acupunture work? It's too bad Mr. Fields did not make this a part of his presentation.
Thank you for your question. This information was not included because of lack of space. Acupuncture works in part by releasing endorphins, the body's own morphine-like chemicals.
Reply | Report Abuse | Link to thisDear Iward,
Reply | Report Abuse | Link to thisTo hear the latest hypothesis for how acupuncture works you may be interested in this recorded interview with Prof. Burnstock. It relates to one of the signaling molecules shown in the figure of the Scientific American article on glia and pain: ATP.
See Brain Waves: http://rdouglasfields.wordpress.com/
I am suffering from neuropathic pain that developed from a leg broken in a car accident 22 years ago. This article describes the progression of my pain symptoms remarkably. However, it seems that the only current effective treatment option available to me is ever increasing doses of narcotics, which my doctor readily admits I will never be able to stop taking if I want the relief, until something better comes along.
Reply | Report Abuse | Link to thisAlthough these narcotics certainly improve the overall quality of my life immensly, there is also a huge downside to the need for the constant pill taking, not the least being the negative perception that the public, law enforcement and even many medical doctors harbor towards this treatment option. Toss in living with the knowledge that I am physically addicted to these drugs and face the prospect of having to endure a painful withdrawal should something happen to my little bottle of pills and daily living with neuropathic pain becomes a daily struggle.
This article gives me, and undoubtedly countless others, hope that there may be more effective and less intrusive treatment options for neuropathic pain on the near horizon.
Hooked, please don't disparage your medications. I also take opiates for chronic pain. However, while physically dependent, I am not psychologically addicted. Most people who abuse opiates take them to get high - usually by crushing and snorting or injecting. For those of us with chronic pain, the medications enable us to live with reduced pain. You are not "weak." You just have to cope with more pain that other people.
Reply | Report Abuse | Link to thisI have neruropathic pain secondary to numerous surgeries for trigeminal neuralgia. I am currently with an experimental sensory cortical stimulator implant which helps with 'tics' from anaesthesia dolorosa (phantom pain) but does not help the neuropathic. Knowing that work is being done on this and that a new explanation and possibly treatments are at hand is wonderful news. It is only the neuropathic pain that keeps me from being able to work. Rid me of that and what a whole new world would become open to me.
Reply | Report Abuse | Link to thisThank you.
Carol Jay Levy, B.A., CH.t
author A PAINED LIFE, a chronic pain journey
member, cofounder with Linda Misek-Falkoff, PWPI, Persons With Pain International,
accredited to the U.N. Convention on the Rights of Persons with Disabilities
member U.N. NGO group, Persons With Disabilities
Just picked up this thread. I shredded 3 nerves in my left leg in an accident 2.5yrs ago, and have had a spinal cord stimulator implant in the UK to try and relieve the need for chronic pain relief via narcotics. Please get in touch if you would like more info. I am struggling with my diagnosis but striving to get to terms with my current issues.
Reply | Report Abuse | Link to thisJust saw this article at my Dr.'s office and was intriqued at the thought that this may be the future in pain medicine. No more general anesthetic or addictive meds. Space and field surgery. Got my vote.
Reply | Report Abuse | Link to thisA knee injury walking into a steel post set in concrete from 1986 hurted for 10 years. Another heel injury after stepping on a sharp object in the sand from 1993 hurted for 12 years. It would be wonderful to know if a compression back injury from 1987 is related to Glia and could be ignored today?
Reply | Report Abuse | Link to thisAny one living with cronic pain has my true sympathies. I am only 20 and i have degenerative disc disease and also last year i herniated two of my disk. I never tried acupunture always wanted to look in to it . Right now i take vicodin everyday which is not great because people make you feel like a drug addict. I just hope they find a better way to treat pain.
Reply | Report Abuse | Link to thisI have been living with cronic pain for 31 long years. In just the last 7 years I have gotten some relief from narcotic pain killers. But it's nice to know there might be some new meds that could help the pain meds work better.
Reply | Report Abuse | Link to thisIt is a sad commentary that anyonoe in pain has the additional emotional pain of worrying that people will think they are addicts. This is the DEA';s fault (and shows like House). Most pain patients do not get addicted. They may become physically dependant but usually do not like the feeling and do not take it for the sensation. I have been on prescription demerol, codeine, methadone, opium, among many others and never, not once, did I enjoy the feeling. It made me feel cloudy and slow. I was lucky in that I never developed a physical dependence (except for the methadone but got off that within 2 weeks).
Reply | Report Abuse | Link to thisIt is bad enough we have to fight pain everyday without also having to fight the DEA, and now the FDA is also trying to get their noses in our doctor's offices and between the doc and patient. Call your legislators (congress.org has the contact info) and the FDA and DEA and tell them we refuse to be further victimized by them. (Anyone whose pain doc has made them sign the contract allowing random drug tests among other conditions/lost their doc due to DEA knows this victimization first-hand.)
Thank you.
Carol Jay Levy, B.A., CH.t
author A PAINED LIFE, a chronic pain journey
member, cofounder with Linda Misek-Falkoff, PWPI, Persons With Pain International,
accredited to the U.N. Convention on the Rights of Persons with Disabilities
member U.N. NGO group, Persons With Disabilities
A fabulous article on the advances in pain control. I know realize that I have an infestation of over-zealous microglia and astrocytes! What are the chances of my physician providing me with one of the newly tested pharmaceuticals to quiet my anxious glia? Thanks for a real insight into this problem of neurologic pain!
Reply | Report Abuse | Link to thisI have fibromyalgia and this truly resonates with me and what I have been writing about on my website! More comments on chronic pain and fibromyalgia, please!
Reply | Report Abuse | Link to thisI would like for people to comment about fibromyalgia specifically and chronic pain!
Reply | Report Abuse | Link to thisUntil these drugs are commonly available and if until then you need narcotics to survive, there's a drug you should know about. It is called buprenorphine (byoo-pren-or'-pheen). It is in a class of drugs called morphine agonists/antagonists which means it has the power to stop severe pain without any 'high', addiction issues, or always needing more to get the same result. It is compounded by hand by specialty pharmacies. The MD who told me about this ran two practices: pain management and addiction cure, both using the same drug. If you need more info, write back. Hope you don't need any pain management and are in the pink.
Reply | Report Abuse | Link to thisTo the people suffering with fibromyalgia: I'm not an MD and this is just a layman's opinion. My research shows that FMS is a sleep disorder due to alpha intrusions, which means that as soon as you get to Stage 3 & 4 sleep where healing occurs, you bounce back up to just below waking, over and over, without even realizing it. Here's a link for treating with Xyrem: http://www.revolutionhealth.com/drugs-treatments/rating/xyrem-for-fibromyalgia-syndrome-fms
Reply | Report Abuse | Link to thisI have tinitis. Based on my experience, and what little trustworthy liturature I've read, it seems likely the origin is my brain, and not my ears. Are you aware of any research that may be pursuing a glial/neural origin for tinitis and related conditions?
Reply | Report Abuse | Link to thisInteresting question. Not enough research has been done on this, but I'll bet you are right. Tumors in the auditory nerve will cause tinitis. You might be interested to know that the nerve cells that become tumors are a type of glial cell (Schwann cell). As a tinitis sufferer myself, I hear your pain!
Reply | Report Abuse | Link to thisIt is lame to charge for access to information. That only serves to limit the affect that good information can have.
Reply | Report Abuse | Link to thisI've had chronic pain due to failed back surgery (L5-S1) in 1973. I lived with and worked with the pain, taking painkillers as needed until 2000 when the pain got a lot worse (and got generalized). I went through an inpatient pain program (University of Miami, everyone got the same diagnosis, and it did not work for me). I take an occasional course of cortisone when I get severe acute pain of the type that many take aspirin for (allergic to NSAIDS) but for daily needs I take ever increasing doses of narcotics. I have detoxed and done 30 days with no narcotics to ramp my doses down twice now - I'm essentially useless for 7 weeks as I detox and then live through the pain, because there is a limit where adding more narcotics no longer relieves the pain.
Reply | Report Abuse | Link to thisI've never gotten a firm diagnosis as to why, in 2000, my pain went from the sort that you can say, "Yes, this is sciatic pain" to "every muscle in my body hurts all of the time".
The first time I was at about a mg/hour from wearing fentanyl patches 12 at a time, the second time I detoxed at about a gram and a half a day of oxycodone. My doctor seems to me more afraid of the DEA than providing me pain relief when my doses get high. I've seen many doctors since 2000, many specialists in the hope of getting a diagnosis, the docs in the pain program, surgeons to tell me if it might be spine related, etc. I've used stimulators, and tried a bunch of alternative treatments, all a waste of my time.
So I guess I am hopeful regarding this research. Obviously something is way wrong with the way my body perceives pain. I'm hoping that research like this will help, maybe, someone develop a pharmaceutical in a new class - something that might relieve my pain.
Thanks for working on this.
Read a story in my local daily newspaper and had to get on line to find this article. As we say here in Australia 'go you good things, go' what wonderful research. My own tale of woe involves failed spinal surgery to save a military career. This horrible pain that I live with can sometimes be all consuming. My son ( 9 ) can not understand why Dad is as flat as a battery and can't play. I do not like to use my pain relief when I am in pain and my wife is not present so that I am not out of it and can at least talk with my boy. It seems there are big possibilities here.
Reply | Report Abuse | Link to thisI also suffer from chronic pain secondary to surgery. I live on narcotics a minimum of 4 times/day, and have, basically, given up my whole life, as between the pain and the narcotics, I am not able to function very well. My doctor has agreed to allow me to start AV411, if I can find out a dose and how to obtain it. (The compounding pharmacist that I work with has not been able to find a way to obtain it.) Dr. Fields, would you be able to help me to find out this information? I would be so very grateful.
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