Neurosurgeon Dr. Christopher Winfree believes that it’s time for an overall revolution in the way we understand, assess and treat chronic pain.
As a pain specialist, Dr. Winfree knows that pain is not always as straightforward as a hammer meeting a thumb. In chronic pain, many body systems interact. The musculoskeletal system, the immune system, the sympathetic nervous system, and chemical and electrical signaling pathways in the brain itself can play a role. Each of these systems is incredibly complex in its own right, and these systems can interact with one another in complicated ways. Some of these systems can be effectively targeted by surgery. Other systems are targeted by different types of medication, or by harnessing the power of the body-mind connection.
But some of these systems and their interactions are not fully understood. In a recent article for the American Association of Neurological Surgeons (AANS), Dr. Winfree describes the work of a patient advocacy group producing a series of peer-reviewed articles about the basic science of chronic pain and the evidence for its nonsurgical and surgical treatment. The group is called the Global Pain Initiative. It hopes to fundamentally change the way people with pain are treated, both physically and emotionally.
As Dr. Winfree explained in his AANS article, he represents the perspective of neurosurgeons to the Global Pain Initiative. Neurosurgical pain specialists like Dr. Winfree specialize in the many surgical treatments for chronic pain. “Spinal cord stimulation, dorsal root ganglion (DRG) stimulation and peripheral nerve stimulation all have good clinical trial data,” he says. That means they have been shown to be effective against certain types of chronic pain in well-designed studies.
Newer surgeries for the brain itself, such as surgeries that target the anterior cingulate cortex, also help a certain number of chronic pain patients find relief. But no one treatment works for every patient.
The new work on pain is particularly timely as families, communities and legislators grapple with the opioid crisis. In the early 2000s, long-acting opioids became available. They provided hope for the safe and effective treatment of chronic pain. But as the medications’ addictive qualities became apparent and the pills began to be diverted to family and community members of chronic pain patients, the crisis began. Now it is a multifaceted problem with no easy solution.
Like the opioid crisis, chronic pain is really a collection of issues, each of which affects individuals differently. There may be no one-size-fits-all solution for either pain or the opioid crisis, but the hope is that with enough research and dedication from doctors, patients and governments, both are potentially manageable.
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