In the series Ouch! we investigate pain. What exactly is pain? And what is it good for? Wouldn’t we be better off in a world without pain? Find out in this four-part weekly series.
Not feeling pain sounds fantastic. Yet you should not want this, several pain researchers emphasize. Because if you don’t feel any pain, you won’t realize that you are burning your hand, walking through shards of glass or have appendicitis. “People with rare genetic disorders who do not feel pain usually do not grow old,” says Monique Steegers, professor of pain medicine and palliative medicine at Amsterdam UMC. “You have to feel pain to survive. That should be clear. It warns you of possible damage.”
Chronic pain – pain that lasts longer than three months – is a completely different story. “That pain is of no use whatsoever,” says Geert Jan Groeneveld. He conducts research into painkillers at the Center for Human Drug Research (CHDR) in Leiden, and is also a special professor of neuropharmacology at the LUMC. According to him, chronic pain is often difficult to treat. “Strong painkillers such as morphine or oxycodone can provide temporary relief, but at the same dosage they quickly lose their effect. Moreover, these painkillers are very addictive.” Therefore, these medications cannot help patients with chronic pain for a long time.
Sanne Bloemink: “It is complicated to talk to those around you about your pain.”
Writer and journalist Sanne Bloemink knows all too well what it’s like to live with chronic pain. She suffered nerve damage during a kickboxing class in 2010 and has since tried various surgeries, therapies and treatments. All in vain. She has now reached a ‘shaky balance’ in relation to her pain. “I can now live quite well with my pain. But as soon as something goes wrong in my life, the system collapses. And the pain takes over again.”
Last September, Bloemink published the book ‘Pijn.’ about her experiences with pain and her search for a solution. An expedition into undetermined territory’. She approaches pain from different angles. “Writing this book has made me realize that chronic pain cannot only be explained physically, mentally, or immunologically. It is an interaction between all these aspects.”
Steegers is happy that Bloemink draws attention to chronic pain through her book. “One in five adults has chronic pain. These people are suffering enormously. They go from practitioner to practitioner. From the general practitioner to the physiotherapist, from the psychologist to the neurologist and from the orthopedist to a pain specialist. And often there is no one who can help these patients from their pain.” According to Steegers, this is not only frustrating for patients, but also costs society a lot of money.
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In addition, chronic pain has a major impact on your social life. Bloemink: “People prefer to avoid the subject of pain. That makes it complicated to talk about it with those around you.” In her book, Bloemink tries to be as honest as possible about pain and what it does to her. “I find myself in an extreme position of luxury with a family, dog, work and friends. Nevertheless, I also regularly have feelings of loneliness.” She thinks it is important to be open about this. “I receive many responses to my book from people with chronic pain who recognize themselves in the book. That moved me.”
Still much unknown
According to Professor Steegers, research into chronic pain is still in its infancy. “For example, the effect of lifestyle on chronic pain has never been studied on a large scale. While there are indications, a healthy diet and exercise can reduce pain.” Groeneveld also states that relatively little attention has been paid to chronic pain in the past. “For too long, we have viewed chronic pain as a symptom to be treated, rather than as a disease to be cured.” Only since January 1, 2022, chronic pain has been on the list of recognized diseases of the World Health Organization (WHO).
According to Steegers, the biggest issue surrounding pain at the moment is: Why do some people continue to have pain? And why not other people in the same situation? “In the past, research has been conducted into whether there are genetic differences that can explain this. But we haven’t been able to find it yet.” She hopes to find part of the answer in people’s lifestyles. Or in psychology. “We know that feelings of depression and catastrophizing – magnifying pain complaints – can cause people to experience more pain. That plays a role, but cannot explain everything. There are still many unknowns that we cannot get a handle on.”
Will science ever eradicate chronic pain? Groeneveld: “We understand this pain better and better, and we are still developing new treatments and medicines.” But he says it remains to be seen exactly when that will be. Because chronic pain is complex and varies from person to person, Groeneveld does not expect major breakthroughs that will provide a solution for all patients with chronic pain. “In our search for new medicines, we always select a specific group of patients where we expect the medicine to have the most effect. This way we prevent a product from being wrongly rejected. Because a medicine that can only help ten percent of patients with chronic pain is also valuable. Then we can at least help these people.”
A new painkiller was recently tested at CHDR, which effectively reduced pain in healthy subjects during the so-called ‘hot pepper test’. In this test, researchers apply capsaicin, the active substance in hot peppers, to the skin of test subjects. This causes a burning pain that, according to Groeneveld, resembles certain forms of nerve pain. “The drug looks promising, and we would like to test it in patients with nerve pain.”
After thirteen years of chronic nerve pain, Bloemink also remains hopeful about a solution in the future. “I am currently on a waiting list for a new operation, for which only a very select group of patients are eligible. They will cut a sensory nerve in my leg, after which – if all goes well – I will have a dull feeling in my leg. That sounds a lot better than pain to me.” But she also has to wait and see whether this operation will have an effect. “Not everyone’s pain disappears after the operation.”