CHRONIC PAIN MAY NEED A NOVEL THERAPEUTIC APPROACH
By- Dr. Joan Marie Pellegrini

Many of us probably know someone with chronic pain. If you do, then you may also be familiar with the difficulty in adequately treating pain in these individuals. Acute pain is the immediate pain that we feel as a warning sign to tell us to stop doing something or to tell us that something is wrong. Chronic pain is pain that continues even when the injury has healed and may be referred to as “pathologic pain”. Often this chronic pain is really a neuropathic pain. Neuropathic means that the nerve is disordered and may be sending pain signals when it should not be. One standard approach to pain is to treat with “pain killers”. These drugs are known medically as narcotics. Narcotics work on the neuron to dim the pain signal.

Scientists have known for a very long time that nerve cells are surrounded by other cells called “glia”. The glia are support cells that regulate nerve activity. They maintain the chemical environment surrounding neurons by delivering energy, sopping up the neurotransmitters and releasing healing factors. New research is showing that it may the glial cell that is more important in the cause of chronic pain. This is important because narcotics do not treat disorders of the glia. In fact, glia may be responsible for the narcotics losing their effectiveness over time (a phenomenon known as tolerance). The drugs that have an effect on glia are very different. For instance, one drug is a type of antibiotic (minocycline). Marijuana is not a narcotic and acts on receptors in the glia to dim the pain response. This is part of the reason why marijuana is being used to treat some cancer patients with chronic pain. Research is focusing on several new drugs that are very early in the development phase.

This new research will have a very important impact. For one, it will be important not to prescribe narcotics for a neuropathic pain if they are not going to be effective. Narcotics can have serious side effects. Also, there will be many patients who have lived with pain who are in dire need of new and better treatments.

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