
Will there ever be a cure for chronic pain? - prostoalex
https://www.1843magazine.com/features/will-there-ever-be-a-cure-for-chronic-pain
======
nate
Tangent from the article, but when I read the headline I thought I'd at least
share in case it helps anyone who might have chronic pain like I've dealt with
lately.

For years now I've been suffering from tons of weird shit. I've had this
persistent painful skin rash that pops up all over my body. Steroids would
kill it for awhile but it would always come back. Folks would ask me if I had
burned myself when they'd see places on my skin. Just chalked up to an allergy
from my doctors (to what? many things they guessed).

To top that fun off, my knees and one shoulder have been killing me. Had
trouble walking up stairs. Couldn't do pull-ups anymore without extreme pain.
I'd wake up in pain. Just constant pain. People just chalk that up to me
getting older. Arthritis I guess.

But then my wife felt like trying to do some Whole 30 kind of thing. I hate
this stuff. But whatever. She needed support so I went along with it. Cut out
gluten, dairy, alcohol, sugar. Low-carb. High protein.

And after a week: I could move my arm above my head again. Walking up stairs
became normal. Huh! Cool!

I thought, maybe my body just needed a reset and gave that diet up.

All this stuff came back.

Now realize how important it is for me to stay on a low-carb diet. It doesn't
seem to be gluten or dairy getting me. But sugar, alcohol and carbs. And I
wouldn't say I was that bad at eating those before. But clearly I'm super
sensitive to them.

Today, I stay on a low-carb diet. I cheat on Saturdays. Allow myself to eat
the nominal sugary treat and have a couple alcoholic drinks. But I barely want
to since my life is just like a billion times better.

All that joint pain is gone. My skin has cleared up. I'm doing pull ups again.
Running a ton. Just did 8.5 miles today.

So, all I know, is if you feel like shit constantly, it might be worth
throwing sugar and alcohol away. Might be worth trying an elimination diet. I
can't believe how long I laughed this stuff off when clearly it's so
incredibly important and has transformed my life.

Edit: I forgot to mention the brain fog I was living with too. There was a
fluid in my ears screwing with my balance. Felt like I had a head cold. Also
has cleared up.

~~~
faissaloo
Sounds like your body was having trouble making collagen

~~~
nate
Oh! That's interesting. Sure does sound like that. Thanks for the heads up!
Huh. Glad I posted this.

~~~
bluewater
Wow, great comment Nate that was rewarded with some equally eye opening advice
for you to look into. I’d like to echo your message of some type of
elimination diet being a valuable experience for anyone. I did the Whole 30 as
well and it truly is amazing to discover how what you eat can have such a
profound effect on how you feel. As I write that it seems so silly and obvious
but until you really get a “reset” it’s easy to get used to feeling pretty
average to lousy.

------
avgDev
Oof.

To answer the headline, there already is a cure to chronic pain and it is
called correct diagnosis.

When i was 21 I had chronic pain for 8 months, doctors gave me anti-biotics,
NSAIDS, steroids.....but pain was just there. After months of research I found
a surgeon in California, who performed surgeries on "Sports Hernia", almost
like inguinal hernia without any bumps. I flew out to have the surgery,
pictures taken during showed almost total rips of internal/external obliques
in my groin area. This was not picked up by an MRI, as specific MRI settings
need to be used. When I called different MRI places to talk about settings
they did not know what the hell I was talking about. If I did not do my own
research, I would literally still be living with this pain. I mentioned sports
hernia to at least 4 doctors and they said it is "rare".

Oddly enough I have symptoms of fibro, after flouroquinolone antibiotics
reaction. It is very frustrating that doctors are ignoring the cause and going
straight to medicating. Side effects of these drugs are widely under-reported,
and many fibromyalgia patients actually are suffering from FQAD, which is
flouroquinolone associated disability. It affects the neurological system and
tendons/muscles.

There is some new research coming to the surface talking about possible mtDNA
toxicity. This would be better treated with supplements that support
mitochondria, rather than medication. Also, best treatment for tendinitis is
eccentric exercise not NSAIDs or steroids.

Additionally, by focusing on treating pain only when there is widespread
tendon issue for example, patients are feeling better, therefore, putting more
load on tendons, leading to more damage but hey at least they are hooked on
opiates, cymbalta or any other wonder drug they come up with.

I'm not saying there is no place for medicating pain, when pain is due to scar
tissue, nerve damage or other. I just have a problem with doctors tossing
whatever medication they can without doing proper research.

~~~
rjurney
There is usually no cure for chronic pain. This is medical fact. Your case is
not descriptive. It is usually not caused by scar tissue, or an infection. For
example MRI reports are only slightly correlated with actual spinal pain. It
generally involves an up modulation of pain sensation in the peripheral and
central nervous system. It is worthwhile to investigate the cause but most
people don't find a cure like you did. There is no cure for most chronic pain
patients.

This is an extremely harmful answer. Do not listen to this person. If you have
chronic pain, see a pain management specialist - a physiatrist or an
interventional anaesthesiologist, or both. There are many non-opioid options
that work extremely well. They can coordinate other care.

For example here's a Quora answer listing just a few treatments for chronic
arthritis pain: [https://www.quora.com/What-do-I-do-as-a-chronic-pain-
elderly...](https://www.quora.com/What-do-I-do-as-a-chronic-pain-elderly-
arthritis-patient-whose-doctor-no-longer-wants-to-write-me-prescriptions-for-
pain-medication-due-to-the-opioid-crisis)

~~~
CuriouslyC
You're falling into the classic trap of thinking doctors know everything, but
sorry to say that's not even close to true. Most doctors know next to nothing
about myofascial pain (even many that really should). I've seen multiple cases
of mobility impairment and chronic pain that even well a respected orthopedic
surgeon thought required surgery be corrected by aggressive bodywork,
including trigger point myofascial release and dry needling.

~~~
rjurney
No, I read science myself. I’ve read hundreds of journal articles. I know the
condition. I read pharmacology textbooks.

You’re espousing hippiedom and it’s top comment because of left wing
ignorance.

~~~
Smoosh
> left wing ignorance

Please don't be _that_ guy.

~~~
rjurney
A leftie disgusted by the ignorance of the left?

------
Wistar
Perhaps naive but from NPR this morning:

"For people who live with chronic pain, getting up, out and moving can seem
daunting. Some fear that physical activity will make their pain worse. But in
fact, researchers find the opposite is true: The right kind of exercise can
help reduce pain."

[https://www.npr.org/sections/health-
shots/2019/09/23/7548691...](https://www.npr.org/sections/health-
shots/2019/09/23/754869132/exercising-to-ease-pain-taking-brisk-walks-can-
help)

~~~
GordonS
I can understand how, for some conditions, exercise could help, not just
physically, but against the depressing effects of chronic pain.

But absolutely not for all conditions. For too long, doctors have pushed
graded exercise programs for essentially _all_ chronic pain conditions,
despite good evidence that it can be harmful, even _permanently_ , for some
conditions (e.g. CFS).

I personally suffer from chronic pain, caused by small fiber neuropathy. I
used to love walking, and I _want_ to exercise - but if I do too much it can
take days or even weeks to recover. A few times, I'm fairly sure I made things
permanently (or hopefully semi-permanently) worse.

So, yes, exercise does help some people, but we must be careful not to push it
as the be all and end all.

~~~
cpncrunch
>good evidence that it can be harmful, even permanently, for some conditions
(e.g. CFS).

No, there is certainly no evidence that exercise can be permanently harmful
for CFS. In fact, all the studies show that graded exercise is beneficial.

It's certainly true that exercising too hard for too long can be detrimental
and can cause a crash, and patients do need to be careful. Exercise certainly
isn't a cure for CFS, and I wouldn't recommend graded exercise myself, but
it's untrue to say that there is evidence that it makes patients permanently
worse.

~~~
GordonS
It's not true to say there is no evidence[0-9].

The Cochrane review[10] that includes the PACE trial has also been beset with
complaints about its methodology[11].

[0]
[https://www.ncbi.nlm.nih.gov/pubmed/21334061/](https://www.ncbi.nlm.nih.gov/pubmed/21334061/)

[1] [https://huisartsvink.files.wordpress.com/2018/09/severely-
af...](https://huisartsvink.files.wordpress.com/2018/09/severely-affected-
me.pdf)

[2]
[https://www.ncbi.nlm.nih.gov/pubmed/19521443/](https://www.ncbi.nlm.nih.gov/pubmed/19521443/)

[3]
[https://huisartsvink.files.wordpress.com/2018/08/bringsli-20...](https://huisartsvink.files.wordpress.com/2018/08/bringsli-2014-me-
nat-norwegian-survey-abr-eng-ver-2.pdf)

[4] [https://huisartsvink.files.wordpress.com/2018/07/de-
kimpe-20...](https://huisartsvink.files.wordpress.com/2018/07/de-
kimpe-2016-rapport-2.pdf)

[5]
[https://www.nivel.nl/sites/default/files/bestanden/Rapport-d...](https://www.nivel.nl/sites/default/files/bestanden/Rapport-
draagvlakmeting-CVS-ME-2008.pdf)

[6] [https://huisartsvink.files.wordpress.com/2018/08/eyssens-
pem...](https://huisartsvink.files.wordpress.com/2018/08/eyssens-pem-get-
primer-december-2017.pdf)

[7]
[https://www.ncbi.nlm.nih.gov/pubmed/28847166/](https://www.ncbi.nlm.nih.gov/pubmed/28847166/)

[8]
[https://www.ncbi.nlm.nih.gov/pubmed/28805516/](https://www.ncbi.nlm.nih.gov/pubmed/28805516/)

[9] [http://www.meassociation.org.uk/wp-
content/uploads/2010/09/2...](http://www.meassociation.org.uk/wp-
content/uploads/2010/09/2010-survey-report-lo-res10.pdf)

[10]
[https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003200.pub7/full)

[11]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176540/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176540/)

~~~
cpncrunch
While it's true that patient surveys generally report worsening after GET,
that isn't quite the same standard of evidence as a Cochrane review. The
Cochrane review had similar conclusions in 2004, long before PACE [1].

A detailed survey by Action 4 ME found that of patients who reported
undergoing GET:

"11 Had NO professional input (had they therefore paced themselves ?) – mostly
with positive outcomes 6 Were supervised by occupational therapists – all with
negative outcomes 3 Had been sent to the gym- all negative outcomes!" [2]

When GET is done properly, it generally involves reducing activity first of
all if the patient is already overdoing it, reducing stress, replacing
stressful with non-stressful activity, using heart rate monitors, etc.

[1]
[https://www.ncbi.nlm.nih.gov/pubmed/15266475](https://www.ncbi.nlm.nih.gov/pubmed/15266475)

[2]
[http://web.archive.org/web/20071019011737/http://www.afme.or...](http://web.archive.org/web/20071019011737/http://www.afme.org.uk/res/img/resources/AfME%20members%20survey.PDF)

~~~
GordonS
We could argue back and forth in perpetuity about the quality of both the
Cochrane review (for example, there are claims that their diagnostic criteria
for even having CFS were not good enough) and the data against GET :)

My point was simply that there does exist a large body of evidence supporting
my original comment, even if there is also evidence against it.

~~~
cpncrunch
Wordpress pages and patient surveys are hardly a "large body of evidence".

~~~
GordonS
We're descending into personal insults now?

That's my queue to bid you _adieu_

~~~
cpncrunch
It wasn't intended as in insult, but I apologise and have edited my comment to
remove that part.

------
dghughes
My dad has rheumatoid arthritis and is in constant pain. Even humeria doesn't
help much.

Now I have started waking up in the morning with hands so stiff I can barely
make a fist.

The pain doesnt bother me as much as the fear of being doped up on opioids.
And the fact organ damage goes along with rheumatoid arthritis.

And to top it off every nut around you says weed or some diet will cure you.
It's always cure not maintain or reduce but an outright cure.

~~~
kirrent
I'm sure you're already on top of all of this and I hope you'll forgive the
tangent, but if you're starting to get RA symptoms you should be acting now.
It used to be the practice of rheumatologists to wait to treat until
symptomatic relief was required by patients. That's no longer the case. The
earlier you act and get on DMARDs (and you might even need to try a few before
getting one that works or finding the one that works best. Humira was
completely ineffective for me), the less cumulative joint erosion you'll
experience, the sooner you'll likely be in remission, and the more likely
you'll be to experience a later sustained DMARD-free remission.

Even if that's not the case and DMARDs don't completely solve the problem for
you, there's a lot of options before opiods for symptomatic relief. From
panadol, through NSAIDs (including the magical COX-2 selectives), and even
steroidals.

Don't give up hope too early. Three years ago I couldn't dress myself. Today I
just got back from a rock climbing holiday.

~~~
dghughes
Thanks for the advice but even if the doctor told dad all that I'm not sure
he'd understand. I've heard of DMARDs but never read up on them if I did tried
to explain it to dad he'd never sit still to listen.

He's still quite strong sick as he is and age 76 he lifted and emptied a large
bucket of rocks, then complained of shoulder pain. I think dementia and old
age are a factor here too, poor judgement. People laugh at the joke "if that
hurts don't do that" but it's too true.

He's on a couple of strong pain meds and steroids. He's a bit better now that
he started oxygen he doesn't look as pale.

I'm glad to hear you're doing well it's a terrible disease not like there's a
good disease. Just make sure to keep an eye on your lungs.

------
einpoklum
> Will there ever be a cure for chronic pain?

This is like asking "Will there be a cure for chronic being-sick?" \- this is
meaningless. Chronic pain has innumerable possible causes. Suppressing the
symptoms to stuff is not a cure.

~~~
ericb
If you look at the causal end, sure. But if you look at the symptom side, why
not?

At the end of the day, pain is reducible to neurons firing in succession. If
you can stop it, interrupt it, filter it or block it, you would have
something.

------
mjevans
Answering the headline: maybe, when we finish getting out of the 'steam age'
of medicine.

Long term might grow closer to current science fiction. Very precise robotic
surgery at an atomic level reconstructs whole bodies (my favorite case being
the beginning of The Fifth Element), less extreme examples also exist and we
might someday get to the point where "knives" are replaced with gentle
'unzipping' tools or even grey-goo that slowly scrubs over an area and just
sets everything correct.

------
anm89
This is a nonsensical premise to me masked by the fact that we use one phrase
"chronic pain" to represent a huge range of experiences. And then because we
have this one phrase we throw the other word cure in front of it like this
semantic trick represents the possibility of achieving it.

I don't buy it. Chronic pain is a thousand different problems and I think it
will be solved piece by piece by debugging those individual problems.

------
rjurney
Acute pain is a symptom. Chronic pain is a disease.

Most chronic pain is not directly connected with a root cause. Spinal MRIs for
example are poor predictors of spinal pain. It is an upmodulation of pain
sensation in the peripheral nervous system/brain stem. It isn't mental and it
isn't psychosomatic - it is very real. And you can't just ignore it - although
there are techniques in pain psychology that help.

This is hopeful, but then so are Nerve Growth Factor drugs and it isn't
looking too good for them at the moment. The second to last drug in trials
failed the safety trial. At any moment we could learn the last drug failed as
well, and then the entire group is DOA. Drug development is horrible to wait
on, for people that badly need the drugs.

Animal trials work in humans what, 10% of the time? This is great research,
but it won't be a treatment for at least a decade, if ever :(

Here's WebMD saying the same thing about what chronic pain is:
[https://www.webmd.com/pain-management/guide/cause-chronic-
pa...](https://www.webmd.com/pain-management/guide/cause-chronic-pain)

"In many cases, however, the source of chronic pain can be a very complex and
even mysterious issue to untangle. Although it may begin with an injury or
illness, ongoing pain can develop a psychological dimension after the physical
problem has healed. This fact alone makes pinning down a single course of
treatment tricky, and it is why health care providers often find they have to
try a number of different types of curative steps."

Psychological is wrong, there's nothing psychological about it - wrong part of
the brain. The brain stem is not psychological, its neurological.
Psychological techniques can help you cope, though.

~~~
cpncrunch
Psychosomatic == real. If your heart rate increases when you are frightened,
is that imaginary?

While some research shows changes in the brainstem, fMRI shows differences in
blood flow in various parts of the brain associated with processing emotions.
Right now we don't have a definitive answer as to what causes chronic pain.
But we do know for certain that the parts of the brain dealing with pain are
also involved in emotional processing.

It's actually very easy to demonstrate to yourself that pain _can_ be
psychosomatic. If you're riding your bike and imagine falling off, you will
experience _real_ pain. (At least, it happens for me, and I assume I'm not the
only person who that happens to).

Here is an interesting fMRI study looking at the effects of pain processing in
both fibromyalgia patients and healthy participants:

[https://onlinelibrary.wiley.com/doi/abs/10.1016/j.ejpain.200...](https://onlinelibrary.wiley.com/doi/abs/10.1016/j.ejpain.2008.06.010)

~~~
rjurney
Chronic pain is not psychosomatic. That has nothing to do with chronic pain.
People like to blame the patient, that they're not trying hard enough to will
their way through it... like you do through any other challenge. That is a
really harmful attitude. You mean well, but you're hurting the people you
treat this way. You should educate yourself about what chronic pain is if you
want to be inspirational rather than causing harm. A chronic pain patient
can't psych themselves out and not hurt. There are some techniques in pain
psychology that help a bit, like mindfulness techniques or imagining the pain
tingles but doesn't hurt, but they're only somewhat effective and that is as
good as it gets in terms of psychology.

------
jririi82zxn
No. Or not in our lifetime, maybe is the better answer.

My gut says a lot of “chronic pain” that ends up hardwiring the brain to be
noticed.

Reinforce a neural pathway often enough and it won’t quiet down.

The buzz will be there and we can’t be sure our sore spot hurts or our brain
simply can’t avoid that pathway.

See phantom limb and similar.

~~~
proverbialbunny
Kind of, kind of not.

When one has enough chronic pain, they lay in bed for extended periods of
time. This deteriorates the muscles, and a lack of muscle strength can create
chronic pain, creating a feedback loop.

It's why chronic pain centers prescribe a physical therapist and muscle
strengthening exercises.

Likewise, as you suspect when it comes to neurology, if something happens over
and over again the brain creates a map for it, which when it comes to chronic
pain can make things worse. One of the solutions found is to prescribe an
antidepressant, even if the person isn't depressed, as it helps rewire those
kinds of parts of the brain. This is why at chronic pain centers there is a
psychiatrist too.

Once those two issues are reduced or removed the chronic pain is often
minimized enough (and sometimes entirely removed) the source of the chronic
pain can become easier to see. Often the pain is still there, but it's no
longer masked. This then helps identify the issue. eg for me, despite being
20/20 I have eye strain. Switching to a 4k monitor helped a lot, but I
wouldn't have noticed a reduction in pain if I hadn't have gone through the
physical therapy and been on an antidepressant for a couple of months.

------
sjg007
Sure, there is always the placebo effect possibly. There is a question though
of those who kill themselves after they've been stung by some kind of snake or
wasp that is apparently so painful that death is the only relief.

------
Cannibusted
Tramadol works great for my chronic pain.

~~~
babyslothzoo
That's because opioids remain the single most effective pain treatment that
humans have available. People have been using them for 4000+ years, they have
a long track record of efficacy (and safety).

Managing pain with opioids is not much different than managing diabetes with
insulin. I realize the media mania and moral panic doesn't convey that because
it doesn't fit the hype narrative, but there is a huge difference between
medical patients and drug abusers.

~~~
rjurney
The opioid action of Tramadol is far less than Codeine. That's mostly not how
it works.

------
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Diet</a>

------
sdegutis
Although there is value in trying to removing pain when doing so would be
ethical, this thread mentions many situations where there is pain but no
possibility yet of removing or reducing it. In these cases, a long-term
general solution is to continue research on these situations. But the short-
term solution per person is to learn the meaning and value of suffering. It is
frowned upon in intellectual forums to discuss religion, as if religion were
incompatible with logic and reason. But Jesus came to teach us how to endure
suffering without failing in our duties. That is what he did, what he showed
us how to do, and what he gives us the _power_ to do through the Sacraments,
especially Holy Communion. Because this is true power: to endure suffering
without failing. And evil means failure because it is an absence of power to
do what is both good and proper; sin is simply a lack of power. You will not
learn any of this in any philosophy or world-religions class, or intellectual
discussions over caviar. You will only learn and understand this through
experiencing it, which can only be started by a humble trust that Jesus came
into this world to suffer and die for our sake, out of love for us, and he
will teach us how to do good, even in the midst of suffering. He knows our
pain better than we do. He suffered more than we ever could.

~~~
searine
Jesus died on the cross in six hours.

Let's see jesus crush a few vertebrae and live disabled for 40 years without
pain meds, and then talk about suffering.

Like I get it. Religion does help many, and it can take you away from pain,
but suffering is real and don't shortchange people's misery who are dealing
with it.

~~~
tasty_freeze
I was going to make a similar comment, so I'll tag on here. Jesus was
supposedly crucified for a few hours, which would be terrible, but he also
knew what was waiting him, and that he would be remembered and revered.

In contrast, my sister suffered through multiple rounds of chemo, then a
divorce by a husband who was jealous that she was "getting all the attention".
The cancer spread to her brain and spine and lungs, and towards the end even
morphine couldn't stop the pain. She had to say goodbye to her sons without
knowledge of what was to lie in store for her or them. When she died, she
stayed dead, none of this "Tada! I died without the consequences of death"
nonsense.

~~~
sdegutis
You assume you know just how much (or how "little") Jesus suffered, based on a
physical description. I felt the same way for a few years. But his was
physical, spiritual, emotional, mental, all at once, for almost a full day
straight, and intensified beyond what you can imagine. He barely showed any
typical signs, like screaming out in pain or cursing people, because he is
all-powerful, and those come from a lack of power. But there are an abundance
of signs that he suffered far more than an ordinary crucifixion, which was
already excruciating by today's standards - in fact that's where the word
comes from.

~~~
tasty_freeze
You are absolutely right -- I don't know how much he suffered. But then again,
people who claim he suffered unimaginable pain because he accepted the sin of
humanity have no idea how much it hurt (if you accept such a thing is
possible).

This is just typical having it both ways -- he was fully human and fully
divine. That isn't some cosmic thing worth pondering -- it is just a
contradiction. If you believe he is god and that it was unimaginably painful,
then you should also accept as god he has infinite tolerance for pain and so
it isn't so impressive.

~~~
sdegutis
He allowed himself to feel the fullness of that suffering to expiate our just
punishments, and to merit for us a portion in his strength to overcome
suffering, and so that nobody could ever say "God does not know what it means
to suffer like I am."

------
wetpaws
As per
[https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...](https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines)
the answer is no.

~~~
DoreenMichele
Let's hope so.

 _No sense of pain can result in severe self-inflicted injuries and premature
death_

[https://www.independent.co.uk/life-style/health-and-
families...](https://www.independent.co.uk/life-style/health-and-
families/health-news/the-people-who-cant-feel-pain-scientists-discover-cause-
of-rare-inherited-condition-that-turns-off-10274604.html)

------
juancn
Should there be one? Pain is a symptom of something else, treat the root
cause.

Managing pain should only be a temporary measure.

~~~
dsfyu404ed
When it's a symptom of some part of your body being worn out there's usually
no treating that.

~~~
proverbialbunny
Actually, that is a common issue with chronic pain, and thankfully that's far
from the truth.

Chronic pain clinics have a physical therapist that shows muscle building
exercises, so the body stops being worn out.

However, depending on what the kind of wear is, as paradoxical as it seems,
going for a walk for at least 20 minutes, can charge an exhausted body more
than laying down without napping.

