Painkillers like opioids are a central element to many forms of treatment and medical procedures because they have been found to be effective in fighting both acute and chronic pain. However, research has begun to show that the actual effectiveness and other side effects of opioids may depend more on a person’s genes than previously thought.
Martin Angst, MD—professor of anesthesia at Stanford University School of Medicine and director of the Stanford Human Pain Research Laboratory—and a team of researchers have found that not only does the effectiveness of opioids have a genetic component, but other adverse side effects do too. “Nausea, itchiness (often accentuated at the nose), dizziness, sleepiness, and respiratory depression (trouble breathing) are all drug side effects that our study showed can be linked to inheritance.” In particular, they found one of the most hated side effects, nausea, to be strongly inherited. They determined this by comparing how identical twins, non-identical twins, and non-related participants reacted to the drugs.
These factors, in turn, are vital issues medical doctors take into consideration when deciding a course of treatment, as some at-risk patients may develop life-threatening complications. “For some patients, a drug’s side effects can be so negative that they outweigh any benefits of pain relief,” Dr. Angst commented. For this reason, patients who suffer adverse effects might be better off taking advantage of alternative methods. This research is an important step for those who would benefit from a more customized treatment plan.
To find out more about Dr. Martin Angst and the study, see Genes may affect painkiller side effects at SFGate.com and an article from Stanford.edu.
Progress was made in the field of controlling chronic pain when neuroscientists at McGill University discovered a chemical that can completely erase memories of pain. The chemical, zeta inhibitory peptide (ZIP), almost seems to be the physical manifestation of the events in the movie Eternal Sunshine of the Spotless mind in which the main character Joel chooses to undergo a process that erases his memory of a painful relationship. Yet, the chemical focuses specifically on the nervous system’s memory of chronic pain due to the fact that pain that lasts for more than a few minutes actually leaves a trace of itself. This would provide a significant improvement for issues such as post-injury sensitivity.
The discovery of the chemical can, however, bring up moral and ethical questions about making changes with the body and mind’s memories but it has been confirmed that it only affects chronic pain, and thankfully leaves other memories intact. While it won’t be seen over the counter, this scientific development will surely make waves in research on other drugs that could make a difference in the lives of people with persistant pain.
To find additional information on ZIP, read about it on Scientific American.
Chronic pain has the ability to strip individuals of their productivity, happiness, and well-being. ABC News wrote this great piece about Tiiu Leek and her pain in the workplace, describing how women feel more pain than men do. The article references a relatively new study from The Journal of Pain that showed women generally feel more pain than men. However, this study wasn’t thorough since it didn’t account for confounding factors such as emotional effects or an additional painful disease. Women tend to be better at analyzing and describing their pain to doctors which give the illusion they feel more pain. As a culture, men are expected to complain about pain less as well as talk about their emotions. One’s mental well-being has a huge effect on physical pain, thus conclusive studies are hard to produce. Nevertheless, the findings reflect what I see as a chronic pain specialist. Here is a telling excerpt from the ABC News article:
Meyer saw 13 doctors before she got a proper diagnosis and the majority were men. “It’s very uncomfortable for them to see real emotion: ‘Tell me the facts, m’am, just the facts.’ I see them tune out.”
Now, she consciously spares the doctor the emotional talk. “I can literally be in so much pain I am crying when the staff is in there, but I pull it together when the doctor is in the room and have no tears at all. And it’s not easy to have to do that.”
She said doctors need to listen more to their female patients – “feelings are a part of the equation … Patients shouldn’t have to shut things down.”
Both Meyer and Leek sit on the leadership circle at For Grace, an advocacy organization that educates, supports and empowers women in pain through annual conferences and legislative outreach.
For Grace’s “Fail First” bill recently got through the California State Assembly’s appropriations committee on a 12-5 vote. If signed by the governor, it will allow women in pain much better access to pain medications, bypassing insurance companies.
As for Leek, she has seen marked improvement in her pelvic pain thought exercise and homeopathic approaches. She also tries to surround herself with positive people.
“My career was lost, but not my optimism,” she said. “I continue to live well. I once read that if you can get through your 60s unscathed, you can have a pretty good life.”
Read this article on ABCnews.com
Many consider pain to be a physical sensation. It seems too obvious that pain originates around the body because that's where many feel it, but in reality pain is created in your mind. Since we perceive the world through our brains as we gather external sensory information from our surroundings, any sort of pain we feel becomes reality. In this way, heartache and mental pain can surprisingly cause physical pain. As acknowledged by the holistic medicinal community, one's mental well-being can effect how their physical bodies feel. In this recent Scientific American article, author Christie Wilcox explores how emotional turmoil caused by those close to us can have very real and physical results:
I know I’m not physically hurt. Though it feels like I’ve been kicked in the stomach with steel-toed boots, my abdomen isn’t bruised. Spiking cortisol levels are causing my muscles to tense and diverting blood away from my gut, leading to this twisting, gnawing agony that I cannot stop thinking about. I can’t stop crying. I can’t move. I just stare at the ceiling, wondering when, if ever, this pain is going to go away.
It doesn’t matter that my injuries are emotional. The term heartache isn’t a metaphor: emotional wounds literally hurt. The exact same parts of the brain that light up when we’re in physical pain go haywire when we experience rejection. As far as our neurons are concerned, emotional distress is physical trauma.
Evolutionary biologists would say that it’s not surprising that our emotions have hijacked the pain system. As social creatures, mammals are dependent from birth upon others. We must forge and maintain relationships to survive and pass on our genes. Pain is a strong motivator; it is the primary way for our bodies tell us that something is wrong and needs to be fixed. Our intense aversion to pain causes us to instantly change behavior to ensure we don’t hurt anymore. Since the need to maintain social bonds is crucial to mammalian survival, experiencing pain when they are threatened is an adaptive way to prevent the potential danger of being alone.
Of course, being able to evolutionarily rationalize this feeling doesn’t make it go away.
I lie flattened, like the weight of his words has literally crushed me. I need to do something, anything to lessen this ache. The thought crosses my mind to self medicate, but I quickly decide against that. Mild analgesics like ibuprofen would be useless, as they act peripherally, targeting the pain nerves which send signals to the brain. In this case, it is my brain that is causing the pain. I would have to take something different, like an opioid, which depresses the central nervous system and thus inhibits the brain’s ability to feel. Tempting as that might be, painkillers are an easy – and dangerous – way out. No, I need to deal with this some other way. Slowly, I sit up and grab the guitar at the foot of my bed.
Where music comes from, or even why we like and create music, is still a mystery. What we do know is that it has a powerful affect on our brains. Music evokes strong emotions and changes how we perceive the world around us. Simply listening to music causes the release of dopamine, a neurotransmitter linked to the brain’s reward system and feelings of happiness. But even more impressive is its affect on pain. Multiple studies have shown that listening to music alters our perception of painful stimuli and strengthens feelings of control. People are able to tolerate pain for longer periods of time when listening to music, and will even rate the severity of the sensation as lower, suggesting that something so simple as a melody has a direct affect on our neural pathways.
So, too, does self expression. Expressive writing about traumatic, stressful or emotional events is more than just a way to let out emotion – college students told to write about their most upsetting moments, for example, were found to be in remarkably better health four months later than their counterparts who wrote on frivolous topics. These positive results of self-expression are amplified when the product is shared w
So, I begin to write. At first, it is just a jumble of chords and words, haphazardly strung together. But, slowly, I edit and rewrite, weaving my emotions into lyrics. I play it over and over, honing the phrasing, perfecting the sound.
The rush of dopamine loosens the knot in my stomach ever so slightly. For now, the agony is dulled. Still, I can’t help but think that I’m never going to really feel better – that the memory of this moment will be seared into my brain, and a mental scar will always be there, torturing me with this intense feeling of loss.
Scientifically, I know I’m wrong. As I close my eyes, I am comforted by the thought that the human brain, though capable of processing and storing ridiculous amounts of information, is flawed. The permanence of memory is an illusion. My memory of this moment will weaken over time. It will be altered by future experiences, until what I envision when I try to recall it will be only a faint reflection of what I actually feel. Eventually, this pain won’t overwhelm me, and I will finally be able to let go.
Read and comment on this article on ScientificAmerican.com.
There is a plethora of really helpful and fascinating scientific research on what causes chronic pain. Scientists are digging through the human genome in order to find what causes the chronic pain that is so disruptive to our lives. The Huffington Post recently released an article on some of the latest findings:
Scientists have found a gene that regulates chronic pain, a discovery that could potentially boost the effectiveness of painkilling drugs, according to a new study in the journal Science.
The gene, called HCN2, is located at the pain-sensitive ends of nerves, Reuters reported. Apparently scientists had known about the existence of HCN2 before, but didn't know what role it played in pain.
Researchers found that by removing this gene from the nerve endings in mice, they no longer felt chronic pain, BBC News reported. They measured their pain response by seeing how quickly they reacted to pain.
TED recently had Richard Resnick — the CEO of GenomeQuest, a company that builds software to support genomic medicine — give a presentation on the research his company is doing. GenomeQuest is on the hunt for the specific genes that produce chronic pain: