New Avenues for Pain Management

We all deal with pain, that of our patients, our loved ones and our own. Yet recent developments in the field of pain management may bring major changes in how we treat these problems. An article in Smithsonian magazine detailed the history of an Italian family who experience very unusual responses to injury. From an early age, members of this family experience pain in a different way than the vast majority of people. One family member fell while skiing, and while she noticed an initial painful response to the injury, it soon faded. She got up and skied another 18 miles. The next morning, she had problems gripping with her right hand. A radiograph revealed a broken shoulder. Certainly, most of us would have responded quite differently. Other members of her family have had similar experiences with both acute and chronic pain.

Pain and its management is a huge problem. The U.S. Centers for Disease Control and Prevention reports that one in five American adults suffers from chronic pain unrelated to a recent injury and lasting longer than six months. The reasons for this are being debated. Some believe it is related to modern lifestyles, while others suggest we are simply paying more attention to the problem. Either way, as clinicians, we should be aware that a significant number of our patients suffer from similar afflictions.

IMAGINE YOUR PATIENTS ONLY PERCEIVING AN INITIAL PAIN STIMULUS THAT QUICKLY FADES

Researchers have found a number of areas in the brain that interpret signals related to pain. While this has advanced our understanding, it has made treatment much more difficult. At present, one of the major therapeutic methods for controlling pain is the use of opioids, yet this has led to abuses and the current opioid crisis. Alternative and effective management methods will be welcomed.

One avenue may involve genetic manipulation. Studies of a Pakistani family (published in Nature in 2006) found that many of its members experienced an altered perception to pain. A specific mutation was found in one of the genes regulating pain sensory neurons. When present, this mutation disables a key genetic determinant, called Nav1.7, which is responsible for alerting the brain to discomfort. Unfortunately, this variant only regulates one pathway for pain. A more promising gene variant, ZFHX2, was found in the Italian family’s code. This gene affects multiple pain pathways, and early data indicate this variant blocks all of them. This was published in Brain in 2017. This last mutation seems to be in the class of a “master regulator,” in other words, if this pathway could be blocked, chronic and severe acute pain might be an issue of the past.

It is difficult to predict the future of pain management, not to mention the vagaries that we now understand are associated with genetic manipulation.  But what a wonderful advance this would be. Imagine your patients only perceiving an initial pain stimulus that quickly fades. Chronic and acute pain could be ameliorated, hopefully to the benefit of all.

Thomas G. Wilson Jr., DDS

Editor in Chief

twilson@belmontpublications.com

From Decisions in Dentistry. July/August 2019;5(7):6.