When Pain is the Diagnosis
This informative article was published in the newsletter of the Interstitial Cystitis Association.
“Chronic pain is not a symptom, chronic pain is a disease” was the strong message of a two-day conference at the National Institutes of Health. Pain and Musculoskeletal Disorders: Translating Scientific Advances into Practice brought together international experts in a broad range of domains in the pain field. Daniel J. Clauw, MD, University of Michigan Neurologist and Interstitial Cystitis Association (ICA) Medical Advisory Board Member was on the planning committee of this meeting.
With the aim of stimulating interdisciplinary research and encouraging faster translation of research to clinical settings, speakers reviewed what we know and don’t know about pain, with a special focus on the role that neural factors play in affecting individual pain sensitivity. Talks covered our current understanding of the science of pain and inflammation, potential advances from animal models and clinical studies, regulatory realities, pharmacological and non-pharmacological treatments, and pain in special populations. Barbara Gordon, ICA Executive Director attended the two-day meeting.
In a thoughtful introduction by Dr. Clauw, who is also a principle investigator on the NIDDK MAPP study, spoke about the concept of chronic pain as a disease state. Drawing upon his clinical experience, he proposed that chronic pain patients may have an increased pain sensitivity “setpoint.” Because the degree of damage or inflammation in people with chronic pain (like IC) does not correlate with the level of pain, doctors may not accurately be able to see the degree of pain which patients are really experiencing. Perhaps this is because there may be a problem with centralized processing—a sensory hypersensitivity which not only causes a greater sensitivity to pain but higher levels of sensitivity to light, noise, and smell. (At the IPPS Meeting in Chicago, we learned that IC patients are “super tasters.” Perhaps the enhanced taste buds relate to the hypersensitivity of smell?)
Leslie J. Crofford, MD, Chief Division of Rheumatology and Women’s Health at the University of Kentucky, encouraged healthcare providers to recognize the need to treat all of the pain. Dr. Crofford said she tells doctors, “Eliminate 90% of a patient’s pain and the remaining 10% is 100% of what is left.
Clifford Woolf, MD, PhD from Harvard University noted the challenge in developing new, effective, and safe pain medicines. He too wants researchers and clinicians to look at pain as a disease and not a symptom and with this new perception, critically assess current approaches for developing new medicines and create opportunities for more innovation in both the laboratory and clinic.
Sean Mackey, MD, PhD, from the Stanford University also presented a call to action for functional neuroimaging techniques in pain, specifically fMRI. Dr. Mackey called upon researchers to move beyond studies which simply report changes in brain activity which he dubbed “blobology.” He wants to know if patients might be able to control their pain by learning how to control their brain activity. He gave a sneak preview of research (not yet published) that suggests it might be possible for individuals to find pain relief by controlling brain signals.
Day two ended with a review of the need for more awareness about the pain treatment needs of special populations defined as women, seniors, and minorities. We have reported before on the need for awareness about differences in gender pain response and treatment approaches. The final speaker, Dr. Carmen R. Green, MD, University of Michigan, highlighted studies about racial and ethnic differences in pain care including less access to pain management specialists, disparities in pain care management approaches, and decreased health due to the inadequacy of pain treatments. Dr. Green summarized the day nicely, noting that Dr. Clauw had brought the multidisciplinary team together for a wedding and it was up to the group to ensure a strong marriage by moving the field forward through strategic collaborations.