BY JOANN PETASCHNICK
Acute pain resulting from a cut finger or stubbed toe is a normal sensation triggered in the nervous system to alert you to possible injury. Acute pain may fade relatively quickly. Then there is chronic pain — a persistent pain that doesn’t fade or stay away for long.
Chronic pain can come from back pain, recurring migraines or fibromyalgia, and it can have a profound effect on everyday life. A person might have suffered an initial illness or injury, such as a sprained back, but others endure chronic pain in the absence of any past injury or evidence of illness. The American Academy of Pain Medicine found that even comprehensive treatment with pain-killing prescription drugs helps only about 58 percent of people suffering from chronic pain.
Fortunately, years of research are beginning to reveal what is behind chronic pain and the ability to treat it. A recent study from the University of Edinburgh, Scotland, disclosed that genetic factors and family environment contribute substantially to the risk of chronic pain in an individual. Researchers working with data from more than 100,000 individuals found that inherited genetic factors accounted for more than 38 percent of the variation in chronic pain risk.
“This is an evolving field, and we don’t have a genetic test right now that could help us see who is genetically predisposed to chronic pain, but what we do know is there are certain factors that seem to affect chronic pain,” says Dr. Sarah Endrizzi of Froedtert & the Medical College of Wisconsin’s Pain Management Center.
According to Endrizzi, observation of chronic pain patients has shown that illnesses such as irritable bowel syndrome, fibromyalgia and low back pain tend to run in families. “There are likely genetic factors at play that change a person’s anatomy as well as how they identify and perceive pain,” she explains. “We might see a patient who tells us that their entire family has arthritis or migraine headaches, for example. When I am aware of this type of situation, treating the whole family is helpful.”
The family environment also contributes to risk of chronic pain, as disclosed in the Edinburgh study and another study conducted by two researchers from Vanderbilt University and Oregon Health & Science University.
Research reveals that people who have a propensity toward chronic pain often have a familial history of abuse, says Dr. Nileshkumar Patel, chief medical officer for Advanced Pain Management. “Many patients come to us with a history of preadolescent sexual abuse, physical abuse or the absence of a father figure,” he says. “These individuals often lack coping skills necessary to deal with pain.”
Children living with a parent who has chronic pain may experience high levels of stress, which can lead to inability to cope with their own pain, Patel adds. The Vanderbilt study found that having a parent with chronic pain may even affect the features and functions of the nervous system during early development, which explains that a baby’s development might be affected by the mother’s stress level or behavior during and after pregnancy. Later on, children could be exposed to parenting behaviors linked to unfavorable child outcomes; for example, the research mentions permissive parenting or lack of consistency and nurturing.
It isn’t difficult to imagine how major depressive disorder is linked to chronic pain. People dealing with long-term pain can become irritable and short-tempered, with good reason. Constant pain can leave a person with a greatly reduced ability to cope with even relatively mundane problems. Additionally, clinical investigators have tested chronic pain patients and found that some have lower-than-normal levels of endorphins, a group of peptides that produces effects such as pain relief, in their spinal fluid.
The medical community offers a variety of treatments for chronic pain, Endrizzi says. “We take a multidisciplinary approach, sometimes using medications, but there are (other) treatments, such as injections, biofeedback and acupuncture,” she says.
Patel is an advocate of using other treatments as well. “We search for ways to avoid using opioid medications. A new treatment for back pain uses high frequency spinal stimulation to help cut down on the use of opioids,” he says.
The future of this field is going to be in genetics, says Endrizzi. “We are now piecing together how it affects people,” she adds. “Someone will develop a genetic test and that will help greatly with treatment.” M