Unraveling the Mystery of Pain

Unraveling the Mystery of Pain

One of the big challenges of medicine has been to figure out what causes pain to become chronic. How can two people have the same exact injury and yet one person have a full recovery while the other’s pain continues to linger and becomes unrelenting? Why does one sprained ankle get better after a few weeks while another turns into a debilitating chronic pain syndrome?

While for centuries doctors have understood the basic process of acute pain that occurs after tissue damage — swelling, heat, redness, sensitivity– solving the mystery of why in some cases the pain does not resolve has remained elusive. But surely unlocking this mystery holds the promise of potentially preventing a disease more common than diabetes, cancer, strokes, and heart disease combined– chronic pain!

bigstock-Migraine-Pain-5625018Fortunately, a greater understanding of what causes acute pain to evolve into chronic pain seems to be now taking place. And a big part of what causes the pain to persist seems to come from an unlikely source, namely, glial cells. Glial cells have historically been thought of as support structures for neurons inside the brain, but the real action of what happens was always thought to revolve around what the neurons do, as they contain the neurotransmitters that conduct information while glial cells do not.

But now it appears that when it comes to chronic pain that glial cells do much more than provide housekeeping support to nerves. In fact research done over the last decade suggest that glial cells are what cause neurons to become over-active inside the brain and spinal cord, making them super-sensitive to pain and perpetuating the pain message. The glial cells cause this disruption in normal nerve function by releasing inflammatory mediators that enhance pain.

Linda Watkins at the University of Colorado has been one of the leaders in researching how glial cells affect pain. Laboratory studies seem to show that blocking the release of pro-inflammatory mediators from glial cells can inhibit a variety of pain states. Once an injury takes place, the inflamed tissue activates the body’s immune system which in turn triggers the glia cells to switch to “pain mode” and that leads to over-excitation of pain pathway nerves in the central nervous system. Once turned on, the glia cells keep the nerves in pain mode.

Now the story gets even more sinister. Not only do glial cells seem to play an important role in perpetuating pain, but they also seem to play an integral part in developing tolerance to opiate pain medications, thereby blocking their effectiveness. Opiates, like morphine, bind to receptors on glial cells, but instead of causing them to quiet down, the morphine actually activates the glial cells to go into “pain mode” so that they release more and more pro-inflammatory mediators which make the pain get worse, as opposed to relieved.

These glial cell discoveries have prompted some researchers to shift their focus from treating the neurons themselves to finding ways to better regulate the glial cells with the hope of preventing or turning off pain states.

Dr. Peter Abaci

Dr. Peter Abaci

Peter Abaci, MD, is certified in anesthesia and pain management by the American Board of Anesthesiology. He serves as the Medical Director of the nationally recognized Bay Area Pain and Wellness Center, located in Los Gatos, California.

Dr. Abaci focuses on developing alternative solutions to treating chronic pain by drawing on neuroscience research, evidence-based medicine, ancient healing remedies, stress management techniques, nutrition principles, exercise programs, art therapy, and real-life lessons.

This column is republished with the permission of Pain Relief Revolution.

Authored by: Peter Abaci, MD

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Stephen S. Rodrigues, MD

This is intriguing insight into how (Mother) Nature works as it relates to pain. The deeper we peer into the histology, microbiology and molecular biologic levels, the more we will find that Nature does not let go those secrets easily. But time is being wasted while men do what they have always done, pay dearly to acquire the knowledge of Gods.

What are these costs?
People suffering in pain and misery waiting for relief, but are shoved under the rug while they sit in anticipation for a blockbuster treatment or drug.

Looking ahead is actually a type of science fiction. Looking into the past is where reality lives and where we have a wealth of experiences to draw upon. 100 or 5000 years ago. Those prior physicians were not dummies. They used common sense to devise therapies that worked with nature to treat the everyday aches, pains, stiffness, bumps, bruises, sprains and strains.

The use of needles and all of the various disciplines is one of those options used that worked when used appropriately.

Many of my patients ask, “How does Acupuncture or needle therapy work?”
My response is “It is hard to figure out how Nature works, it just does, without fail, all the time and that is what I bank on with this therapy.” The needles seem to unlock or ignite the healing systems of repair.

Here are common a few follow up questions:
Q: “Are the needles dangerous?
A: “NO. Actually just the opposite! Being without the needles is very dangerous, to me and you. I use the needles as an office tool like a blood pressure cuff. It is mandatory to use a BP cuff, stethoscope and percussion hammer during an examination. If a provider does not have access to these tools he or she would not be doing a correct job. I view the needles as an office tool and I wouldn’t be doing my job correctly without them. The needles are an extension of your touch, hands and fingers, in effect, allowing you to reach deeper into the examination to gather more data for analysis. Without this data, IMO, that you can not efficiently, thoroughly and effectively find and treat long-term pain. So, the danger is not having the vital data collected by the needles to uncover the best treatments for long-term pain.

Q: “Why don’t other doctors use needles?”
A: “Tough question! Many doctors are fearful and have not given themselves the permission to venture out of the standard box to understand alternatives. Others have been brain washed or have an agenda to negate the benefits of needles. If they see or hear the word, “acupuncture” they immediately go into a offensive rage dispelling the benefits as placebo.

Humans use bias, resentment, disdain and disbelieve as a way to perpetrate an agenda. Thus promoting the status quo, which is to sweep more people under the rug.

“When the solution is simple, God is answering.” – Albert Einstein.

Dr. ray – would love to read American Academy of Pain Medicine textbook: Comprehensive Treatment of Chronic Pain but the cost is…wow. Do you know where there may be a copy of sections of the book? Or maybe a report along the same lines that’s free? It’s good to see a doctor offering insight and a place to reference. Thank you.

Wendy

The research, while still ongoing, is likely part of the reason some docs think opiates do not work to quell pain. But this is lab work, not real people so it may not translate. And if it does, then only for “immune mediated pain.”
Doctors are human, too, so do fall for the newest research that may be in line with what they want to do anyway. I mean, who would want the hassles presented by prescribing opiates? Thankfully, some good docs still do!

Albert Ray, MD

Pain is a perceptual experience, influenced by many factors including nerve input, glial cell input, recruitment of non-pain nerves into becoming pain nerves, memory, thinking, and cognitions. The amount of input from any one of these multiple factors can vary from day to day. Acute pain becomes chronic pain when the nervous system and brain sensitizes and undergoes neuroplastic changes, which result in both anatomical and physiological alterations, changing how the system functions. There is no one change that can be labeled as “the cause” (glial cells are but one part of the change), but the switch happens when there is gene expression change.
For further information, I would refer you to the American Academy of Pain Medicine textbook: Comprehensive Treatment of Chronic Pain, published in 2013. Check out chapters 70 and 71 for a fuller discussion of what pain is all about. One of the other commenters questioned why he can handle some pains and not others. These chapters may help give an understanding of that.

Let’s throw another wrench into the works, on a few things. First, Why, if glia cells create hypersensitivity to pain, am I able to handle other pain, like minor surgery without anesthesia, or severe kidney pain for days that became emergency surgery, or a severe burn on my arm from 350 degree oil, and more? Do the glia cells know that “the doctors aren’t gonna believe you with the spine pain so we’ll become hypersensitive, but only on that.” (?) Also, when I appeared to become tolerant of a few different meds, like morphine, and we tried different combinations only to end up back on morphine and mixed with a different combination of drugs, became the answer for the last 5 years in a row! Doesn’t make sense huh. What about the “Secondary pain”, the pain effect or amplification caused by outside influences? And we know everyone is different when dealing with stress. So when these tests are underway, is anyone able to measure the “secondary pain” or even the primary pain so they can eliminate its effect from the results? I really believe that we should be testing doctors and insurance companies to see if they are able to know how exactly to treat a person with chronic pain. The people I know that “deal with pain better than others” or those who, like myself, miraculously “see” pain differently which completely changed my life, have all been able to keep the “secondary” effect of pain separate from the primary pain. To me, the proof is in the traumatic occurrences. If medical professionals learned more about how to help a patient live with the pain, how to keep the primary and secondary separate, how to remain positive in a very negative situation, it would be money and time better spent. It seems to me this all starts with BELIEVING the patient and showing real concern and caring for their disease, even when chronic pain is the only provable disease. I was so lucky that after 4 years of being spit on by the system I was able to find a pain clinic who treated pain as a disease unto itself, and from that found the cause of my primary pain. All that changed was their approach. It led to a life changing event and, for me, has allowed me to live the past 10 years, happy and as productive as possible, while my incurable disease deteriorates. So how about if we “shift the focus” onto some things that will help people in pain immediately, and permanently. Start with believing them and then, actually believe them. Then, go from there. Someday we’d love to know why it hurts, but for now, just accept that it does hurt and we need our lives back, at least until the kids are grown! By the way, it was in Colorado that all my problems flourished and the system took everything from me. As a homeless person I had to move to another state, where,… Read more »

Phyllis Jones

I was diagnosed with chronic pain 6 years ago…..I recently move to Al. And have had nothing but problems with getting these docs on board. I had the same doc prior to moving here and with no compassion have been called a drug addict, I have run out of my meds, gone into horrible withdraws and I am at a loss. I went to on doc and she told me more than 8 pills a year is abuse………I had to walk out, does pain management mean anything? Feeling helpless and lost…….and in excruciating pain!