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Loss of nerve: a molecular approach to better treatment of chronic pain.

MIAMI—In the last decade, efforts have been made to increase physician awareness of the ravages of chronic pain and the need to adequately treat it. In this same period, researchers have made great strides in understanding pain, knowledge that has yielded new approaches to treating long-term intractable pain. One promising novel treatment is a molecular neurosurgical approach that selectively targets nerves involved in pain transmission. “Classically, chronic pain has been treated in a number of different ways,” said Lorne Mendell, PhD, of State University of New York at Stony Brook, at the annual meeting of the Society for Neuroscience held here in October. Opiates and surgery have been used, he said, and in many cases have been helpful; but these approaches are not without adverse effects or risks that can compromise a patient’s quality of life. Nor are they effective in treating all types of chronic pain. Drawing from a surgical example, Mendell said that in cases of severe intractable pain, neurosurgeons may cut various nerve pathways to relieve suffering. But among the many problems with surgery, he said, “is the fact that the nervous system is not color coded, making it very difficult to selectively lesion pathways.” Other sensory and motor nerves can be inadvertently severed, increasing the risk of paralysis or loss of sensation.