Introduction to Chronic Pain Management
Over a hundred years ago, William Osler, the Canadian doctor and founding influence on modern medicine and medical training, emphasized the importance of "listening to the patient." Today, this approach has become increasingly relevant in the urgent search for sensible insights into chronic pain. Health service providers now encourage patients to become partners in the treatment process, and research programs include people with experience, such as patients, family members, and caregivers, as members of advisory committees.
Reverse Translational Research
Pain researchers are calling for a dramatic change in the way studies are conducted. Reverse translational research begins with the patient’s real experience and then uses laboratory-based research to develop targeted solutions for effective pain treatment. This approach turns the classic bench-to-bedside process on its head, starting with the patient’s symptoms and self-reports, and then using brain imaging and blood tests to decipher the underlying mechanisms.
A New Approach to Pain Management
Prasad Shirvalkar, a pain doctor and neuroscientist, used a hybrid approach to find objective biomarkers of subjective pain experiences. He implanted electrodes in patients’ brains to measure brain signals and then followed them at home, tracking their pain levels with continuous surveys and digital surveillance. The combination of laboratory-based and home-based surveillance led to a groundbreaking series of clinical studies that made headlines worldwide. In 2023, his team was able to map chronic pain signals directly in the brain, creating an objective measure of subjective pain experiences.
Predicting and Preventing Pain
In a newer study, Shirvalkar’s team used electrodes to predict pain outbreaks and then used deep brain stimulation (DBS) to interrupt the pain and reduce or eliminate it. This approach provides evidence that pain circuits in the brain are measurable and modifiable, and can be targeted and treated. While this treatment is not yet available for general use, it offers hope for the development of new approaches to chronic pain management.
A New Era in Pain Research
The work of researchers like Shirvalkar and others is leading to a new era in pain research, one that prioritizes the patient’s experience and uses innovative techniques to develop targeted treatments. By listening to patients and using reverse translational research, scientists are making progress in understanding and managing chronic pain. This new approach offers hope for the millions of people worldwide who suffer from chronic pain, and may ultimately lead to the development of more effective treatments and a better quality of life for those affected.
