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What We Can Do about Pain

Prevention magazine discusses the fundamentals of pain and treatments for acute and chronic pain with guidance from experts including Anuj Malhotra, MD, assistant director of the division of pain management at HSS.

Dr. Malhotra explained for acute pain like that of a headache or a broken arm, one might take acetaminophen or a nonsteroidal anti-inflammatory (NSAID) like ibuprofen, both of which are non-opioid analgesics that “decrease the production of painful mediators called prostaglandins.”  

However, what causes chronic pain though, is sometimes completely different, so the same treatments may not work. “You don’t have the same responsiveness to those medications, or they may become less safe in certain patient populations with longer-term use,” he noted.

He explained, “Opioids cover pain regardless of the source, but they don’t treat the cause of the pain.”

According to Dr. Malhotra, with no way to address the pain trigger, the body gets used to the medication, so “you’re going to need a higher dose in order to get the same results.” With a higher dose come more side effects and the potential for overdose or addiction, he added.

There has been greater attention to innovation and non-pharmacological treatments. Spinal cord simulation is promising in which a small insulated wire or lead is placed along the spinal cord above the area where the pain is generated. Dr. Malhotra continued, “For example, if you have pain in your legs, those signals come into the lumbar spine, so the leads are placed in the thoracic spine and you can modulate the signal before it gets to your brain, where you process it.”

He added that in some cases modulation could be something you feel, like warmed or a buzzing sensation that replaces the pain or it could be at a high frequency that blocked the pain signal, meaning you wouldn’t feel anything.

Additionally, new medications are in the works inspired by congenital insensitivity to pain (CIPA) a condition that prevents people from feeling pain. According to Dr. Malhotra, in people with CIPA, “often there is a mutation in a particular sodium channel throughout the body, so there are some medications that are targeted toward purposely inactivating this channel more specifically to treat painful areas.”

This article appeared in the April 2022 issue of Prevention magazine and online at Prevention.com. A subscription is required to access.