What is the source of the discomfort?
This apparently straightforward inquiry does not necessarily have a straightforward solution. Pain is widely recognized by researchers and medical practitioners as the body’s warning mechanism for a biomechanical problem: it serves as an alert when a finger is cut, a joint is swollen, or a tumor is forming. The underlying condition will be treated by medical personnel, and the discomfort is expected to subside. But what happens if the alarm does not go off? What happens when the discomfort persists even after the tissues have healed? What occurs when there is pain even though there is no tissue damage? This week’s Nature Feature contains some answers.
Pain is a medical condition in and of itself. Every day, millions of individuals across the world suffer from chronic pain, which is defined as discomfort that lasts longer than three months. It is expected to impact more people in the next decades, as the prevalence of obesity, diabetes, and autoimmune illnesses rises. All of these factors enhance one’s chances of acquiring chronic pain. Pain is another symptom that might persist after a SARS-CoV-2 infection. Even in triple-vaccinated adults, around 4% of persons with Omicron variant breakthrough infections acquire protracted COVID.
Chronic pain has multiple symptoms and causes, and fundamental research in neurology and immunology has greatly aided our knowledge of it. Geneticists and epidemiologists are investigating the heritable and environmental risk factors. Chronic pain is also being linked to a complex combination of neurological, immunological, psychological, and social variables. A person’s pain can be caused by a variety of variables and processes, which might alter over time.
Integrative medicine is in high demand.
However, the multidimensional character of pain is frequently overlooked by the medical establishment, particularly doctors. Medical research is beginning to interact with this biopsychosocial concept of pain, and medicines that can, to some extent, assist to silence those insistent sirens have been produced. However, getting the correct mix of therapies, or even any treatment at all in certain circumstances, is difficult. One significant impediment is the failure to recognize the usefulness of complementary therapies such as yoga, acupuncture, and psychotherapy, in addition to medications. Health-care legislation and insurance systems can also be a hindrance in specific situations.
Integrative treatment, for example, incorporating pain psychologists, physical therapists, and spinal experts, can sometimes be more successful than single procedures, such as steroid injections, in treating chronic pain. However, in the United States, these more comprehensive treatment programs are frequently excluded from health-insurance coverage. Furthermore, some US health-care practitioners are known to favor therapies that pay them more from insurers, even if there are more effective (but less lucrative) options. If a doctor gets paid the same for delivering a 30-minute steroid injection as for providing a considerably longer course of therapy, the shorter, more lucrative alternative may be favored. Many people are unable to benefit from treatment alternatives since the country lacks both universal health care and statutory paid sick leave.
Social views must be altered.
Of course, difficulties with treatment access are not limited to nations lacking universal health care. It is not uncommon in Australia for patients to have to drive for five or six hours to visit a pain clinic. People in the United Kingdom who use the National Health Service generally face a year-long wait before they may begin a pain-management program.
Many of the problems with treatment access may be traced back to individual and cultural attitudes that fail to prioritize chronic pain and chronic diseases. Some even fail to identify a person’s true grief. Despite a plethora of data regarding the neurological basis of fibromyalgia, for example, a survey last year indicated that some UK clinicians do not believe it is a separate, or real, disorder (N. Wilson et al. BMC Health Serv. Res. 22, 989; 2022). According to the study’s authors, several of the doctors’ comments were so unpleasant to patients that they were not published.
Researchers are obviously contributing to the answer to the question ‘why does it hurt?’ but chronic-pain research needs to be better financed. Because of the mixed history of the use of opioid medicines to relieve pain, the US National Institutes of Health funds pain research alongside addiction research. Both areas are essential, and in theory, there is no difficulty with categorizing money in this manner. However, the US HEAL Initiative, one of the world’s largest financing programs for pain and addiction, devotes two-thirds of its funds to addiction research and one-third to pain research. This rationale is more harder to understand.
Approaches that fail to address the numerous complex factors of chronic pain and even deny its existence cause unneeded misery for millions of people. Reform is required to guarantee that persons suffering from chronic pain get access to the therapies that are most likely to assist them. Furthermore, the stigma and prejudice that characterize the medical and cultural narratives surrounding chronic pain must be eliminated.
Erin Balsa is a highly skilled and knowledgeable health journalist with a passion for educating the public on important health and wellness topics. With extensive experience in both traditional and digital media, Erin has established herself as a trusted voice in the field.