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Understanding Chronic Pain

By Shlomo Maital  

     [Warning:  Long wordy blog, 1,200 words.]

       “Conservative estimates suggest that chronic pain affects over one and a half billion people, or 20% of the world’s population.”    

        Typically, chronic pain is treated with pain relievers.   “The global market for analgesics was valued at $53.5 billion in 2024 and is projected to reach $72.8 billion by 2030.”  This is big business.  And rather risky.   

      The main painkiller medicine is comprised of opioids (from ‘opium’), such as OxyContin. They are addictive and overdoses kill.   OxyContin is the trade name for oxycodone, produced and sold by Purdue, and the Sackler family. 

       “The number of annual opioid overdose deaths remains more than six times higher   than it was in 1999; There were approximately 81,806 opioid overdose deaths in 2022   and 90% involved synthetic opioids other than methadone.”

        So if you have chronic pain —  is there an alternative way to deal with it, other than opoids?    Here is what I learned from a great episode of a podcast, Science Friday:

       Chronic pain is remarkably common: Roughly 20% of adults in the US live with it. And people with chronic pain are more likely to have depression, anxiety, and substance abuse disorders. But this relationship between physical and mental health is not as straightforward as you might think, and there’s still a stigma attached to neuro-psychological causes of chronic pain.

     “The latest research suggests that untangling the connections between mind and body is a key part of developing better treatments for people with chronic pain. Now, a new psychological treatment called pain reprocessing therapy has shown initial success in eliminating back pain in research participants

      Guests:  Dr. Lauren Heathcote is a Senior Lecturer in Health Psychology in the Institute of Psychiatry, Psychology & Neuroscience at King’s College London in London, England.  Dr. Yoni Ashar is an assistant professor and Co-Director of the Pain Science Program at University of Colorado Anschutz Medical Campus in Aurora, Colorado.

         Flora Lichtman (SciFri contributor):   “Roughly 20% of adults in the US live with it. And people with chronic pain are more likely to have depression, anxiety, and substance abuse disorders.   But this relationship between physical and mental health is not as straightforward as you might think. And the latest research suggests that untangling the connections between mind and body is a key part of developing better treatments for people who have chronic pain.

          Expert guest Dr. Lauren Heathcote:  “In the case of chronic pain, it’s more the case that the brain is getting it a bit wrong. So it might be that there was some sort of initial injury, but that that has now healed, or potentially that there is still some ongoing inflammation in the body, some kind of bodily damage in some way, but the brain is still producing a pain signal even when it’s not particularly helpful anymore.”

         Expert guest Dr. Yoni Ashar:  “The way pain is processed in the brain is quite complex. There’s no one region that’s the pain region. Pain is processed, everywhere and nowhere. And we see changes along all parts of the pain processing pathways. ….a lot of people come to us thinking that their bulging disk or their arthritis or et cetera, that’s the cause of their pain. And the major step is education, that actually bulging disks and arthritis are highly prevalent in people who have no pain whatsoever, and they’re typically not related to the pain… And that education to help people shift their thinking to this pain is actually not a sign of tissue injury. This pain is an indication that my pain system has gotten sensitized.”

           Science Friday producer, Shoshannah Buxbaum: “One of the new treatments is called pain reprocessing therapy. It’s designed specifically for people who have pain that’s primarily due to changes in the mind and brain. The goal is to have patients unlearn the pain pathways that their brain has formed, which are, in turn, causing them to experience pain. So step one is educating patients on the science of chronic pain and what’s actually going on in their bodies.”

         “The first study testing the efficacy of pain reprocessing therapy was in patients with chronic back pain. And back pain is among the most common chronic pain conditions in the US. Severe chronic back pain affects over 8% of adults in the US, and lower back pain, specifically, is the most frequent cause of job-related disability in the country.

       “I wanted to understand what going through this type of therapy was actually like. So I talked to Sal, who is a participant in that first study. We’re just using Sal’s first name to respect their privacy. So I started off by asking them about when their pain first started.

    SAL: I mean, I first noticed my back pain beginning in high school around when I was 15. I’m in my 30s now. So it’s been probably more than half my life at this point. It was a daily thing. It’s something I woke up with every day. And I think I just almost resigned myself of, like, this is just how my body feels, right.   So I met with John. He does pain reprocessing therapy. And he himself had also benefited from the treatment greatly. We met for an hour once a week for six or eight weeks. Part of the treatment itself is acknowledging, from the cognitive standpoint, of reminding yourself that you’re safe and that your body doesn’t need to be feeling fight or flight.

    “ Learning about the research and learning about how pain works in the brain and the body is part of the treatment. And I told John, throughout the whole process– I said, this is really dumb. And he’s like, I know. Because it almost feels like there was nothing intensive. There was nothing that I radically learned that was different. So it would just be breathing exercises and focusing specifically in this spot in my right shoulder that feels uncomfortable or feels pain.

    “And what is the quality of the pain? Does it feel tingly? Does it feel sharp? Does it feel cold? Does it feel hot? So noticing on the actual sensation of pain, and trying to spread that out or dissolve it a little bit, or just focusing on it and taking a deep breath while focusing on it. And so just taking a moment to remind yourself and your body that you’re safe and that you don’t have to carry that tension or that pain. And just even the small act of doing that provides relief.

    “I would say I went from a daily, waking up, six or a seven pain, and just chronic all day, and increasing or decreasing, depending on my stress. But I’m at a zero or one. And even now I’m skeptical. I’m like, oh, really? I don’t wake up with pain anymore? That’s cool.”

        Expert guest Dr. Yoni Ashar:  “When we started this work, I was concerned that people would storm out of our offices and feel dismissed and invalidated. But more often it’s the opposite of people telling us, wow, now things make sense. I saw 10 different doctors before this who had 10 different stories, and none of it really made sense or could explain all my symptoms. And now, for the first time, things are falling into place. Things are clicking.”

         “For some people with chronic pain, there’s a big component of trauma and history of deeply entrenched patterns of self-criticism. These make it a lot harder to just try to treat the pain in isolation. What we’re finding is that for a number of people you can’t just talk about the pain and expect everything to get better, but it will require a deeper dive into what’s making them feel unsafe more broadly. And trying to help people resolve those other mental health challenges will be the key to helping their pain.”

      Perhaps one day, alternative approaches to chronic pain relief will put the Big Pharma big bucks out of business.  And fewer people will die of overdoses.