This begins with a recent story in The Washington Post. Here’s a link, which I hope you can access.

Chronic pain is surprisingly treatable — when patients focus on the brain

Summary: the author views the medical community as having long followed an unproductive path when it comes to one of their most difficult challenges —  chronic pain. Given that an estimated 50 million Americans qualify for the description, the potential impact of an improved treatment protocol would be enormous.

A few things we’ve learned about chronic pain over the past few decades, mostly through trial and error:

  • Simply opening up the tap for prescription painkillers isn’t a viable solution. Their effectiveness over time is doubtful, plus there are just too many risks involved, overdose and addiction among them.
  • What we call chronic pain – experienced on most days over a minimum period of six months – is now seen as the result of neurological and psychological factors instead of tissue damage elsewhere in the body.

That may seem obvious in hindsight. Opioids act primarily on pain centers in the brain, not the neck, shoulders, back, hips, knees, or wherever else pain symptoms are felt. That’s a clue that brain function might be the place to concentrate our efforts.

In a paradigm shift, chronic pain is viewed as a disruption of the body’s warning systems. Somehow the brain has become conditioned to interpret certain stimuli as a threat, and responds with warning messages in the form of pain. The warning lights continue to flash even in the absence of any genuine physical danger. The brain, the analogy goes, has “learned” to misidentify pain. This has caused serious problems for the sufferer.

We wrote earlier about Chronic Pain Syndrome (CPS), believed to be present in perhaps 25% of cases. CPS is characterized by feelings of depression and anxiety that can be resistant to conventional medical remedies. Its adverse effects on mood, personality, sleep, and other key areas of function are well-documented in the literature. What’s been missing is a genuinely effective treatment for many in this situation.

Medical professionals have long thrown up their hands at the sheer persistence of CPS. That’s why some physicians settled into a pattern of long-term opioid prescribing. “Tell me what else I can do,” argued one family doc. “I know the patient is probably drug-dependent, but he absolutely freaks out at any suggestion from me about cutting back. He thinks it’s all my fault for not prescribing enough meds. And if I bring up the issue of addiction, he explodes.”

Of course, we see CPS sufferers in addiction treatment programs, for the obvious reason. Most counselors would welcome a way to help them find relief without opioids. The WaPo article describes one serious candidate, along with the promising outcomes that emerged during trials.

The key study, we’re told, “…involved eight one-hour sessions of a new treatment called Pain Reprocessing Therapy (PRT). Pain patients learn to reinterpret their pain as a sensation that is “not necessarily proof they’re experiencing genuine physical danger.” Patients are encouraged to evaluate some of their pain as they would a  burglar alarm that’s gone haywire, sounding its warnings without an identifiable cause. It’s a method of reinterpretation that’s used in therapies for other chronic conditions, such as anxiety and panic episodes.

Anyway, as always, further research is required. Still, I thought the initial results were worth mentioning.