Will we cure pain?

As I flew over my handlebars and landed with a crunch on the road, I knew there was an excellent chance I’d hurt my back. And indeed, I had, but it lasted much longer than I — a young, fit, healthy PhD student at the time — could have imagined, writes Prof Mark Hutchinson.

The acute pain that sidelined me in the days after I picked myself up off the road developed into 4 long years of chronic low back pain.

In the first couple of years, I tried all sorts of therapies, like drugs, Pilates and acupuncture, but none provided lasting pain relief — so I can understand people who say pain treatment doesn’t work. But that won’t be the case forever, if I have anything to do with it.

Granted, the situation has improved in recent decades, but the truth is we’ve generally handled pain treatment terribly. Until the late 1990s, chronic pain wasn’t often recognised by doctors. When it was diagnosed, it was treated like acute pain — a prescription for quick fixes like opioids that may provide short-term respite, but intensify pain in the long term. That medications affect everyone differently was basically ignored.

Our collective pain management wasn’t helped by biases in research, either. Today, many drug discovery studies use male rats and human subjects in early trials. Yet we know women live with more chronic pain than men.

We also know genetics, life experience and even our headspace at the time of injury can nudge acute pain into the chronic state.

But there’s still loads to uncover. These days, nearly 20 years after my bicycle injury, I am director of the ARC Centre of Excellence for Nanoscale BioPhotonics (CNBP) and lead a laboratory at the University of Adelaide that is unpicking the two-way relationship between our immune system and brain to discover how it causes and maintains chronic pain.

Why, on a molecular level, does acute pain turn chronic in some people but not in others? Which parts of the brain and spinal cord are responsible for different pain conditions? And how can we tailor medication to target those pesky cells and — ultimately — cure pain?

For instance, people experience different types of migraine, so they should be treated accordingly. Today, most benefit from a class of drugs called triptans. I think researchers will eventually break responder and non-responder groups into smaller portions of the ‘migraine’ pie, each slice having specific and effective therapies.

To this end, my vision is a pain test in clinics that, with a simple finger-prick blood test, makes a quick and accurate diagnosis and tells the clinician what treatment combination is best for the condition. Treatment will also become ever more personalised as we learn more about how psychological, physical, environmental and social factors affect pain development.

Such innovations will lead to faster analgesia not just for us, but for livestock too. We farm animals for our use, but they’re not exempt from discomfort, so the least we can do is ensure the millions of cattle, sheep and pigs on Australian farms live the happiest, healthiest life possible. Eventually, I think farmers and their animals alike will receive similar pain treatment.

And what I suspect helped me and my sore back most was getting back on the bike and — perhaps crucially — changing the way I thought about the pain. I knew the damage I sustained from hitting the bitumen had well and truly healed. There was no reason for my back to hurt, and my pain eventually disappeared.

I see a future where medication isn’t necessarily the first option for chronic pain, but where interventions incorporate a combination of therapies that address body, mind and our environment. They will work first time, and pain will no longer be the debilitating condition so many people endure today.