If you’ve ever tried to describe a sore lower back to a physiotherapist or migraines to a doctor, you may have found yourself struggling to articulate precisely how you feel.
That’s because pain is personal. We all experience it differently. And language doesn’t quite communicate our experience of it, so it’s difficult for clinicians to prescribe a treatment that fixes the problem first time round.
This may not be the case for too much longer. ARC Centre of Excellence for Nanoscale BioPhotonics (CNBP) researchers are working on techniques that could help deliver personalised pain medicine.
Unlike acute pain, chronic — or persistent — pain does not go away when a threat or injury disappears. Symptoms are non-specific and have no apparent cause, and people living with chronic pain must often see multiple clinicians before their condition is recognised.
This is particularly true for women, who are more likely to experience chronic pain than men, says Prof Mark Hutchinson, CNBP director and leader of the University of Adelaide’s Neuroimmunopharmacology lab.
Around half of our pain experience and propensity to transition to chronic pain — our chronicity — is inherited, he adds: “We don’t understand what all those genetic markers are yet, but there’s a myriad involved.’
Then there’s the nurture side of the equation. Individuals who were abused or experienced violence during development experience drastically higher rates of chronic pain later in life, Prof Hutchinson says. Factors at time of initial injury, such as sleep, drug exposure and life circumstances, also contribute to chronicity.
Broad bandaids to tailored treatment
With many elements feeding into pain tolerance and susceptibility to chronicity — not to mention the countless ways persistent pain presents itself — it follows that therapies should be personalised.
Only in recent years have researchers developed a model of pain that encompasses psychological, physical, social and environmental inputs alongside physiology. Current best practice chronic pain therapy is delivered by a multidisciplinary team including pain specialists, nurses, physiotherapists, occupational therapists and psychologists.
That’s not to say pain medication doesn’t have its place. Multidisciplinary therapy is more effective when coupled with the right pharmaceuticals, Prof Hutchinson says. To this end, he and other CNBP researchers are developing objective measures that provide information about a patient’s pain experience so appropriate medicines are prescribed.
Blood biomarkers produced when parts of the central nervous system are stressed may form the basis of one objective measure. Hyperspectral imaging, a technique that analyses the ‘colour’ of blood, has the potential to speed up precise diagnoses too.
‘As time goes on, we continue testing,’ Prof Hutchinson says. ‘Is the pain in the somatosensory cortex? Or is it now at the level of the spinal cord? Do we need to change the drugs to target different anatomical compartments?’
This, he adds, is the challenge. But he envisions a future where data-driven precision medicine-based interventions become the norm — with many excluding medications.
‘A doctor might tell a patient, “I’m prescribing you 20 sessions with a psychologist,” or, “I’m prescribing you six months of physical activity,”’ Prof Hutchinson says.
‘The patient has their quality of life addressed faster, there are drastic reductions in healthcare costs, and the person can return to their job, which then benefits society. Everybody wins!’