Epigenetic Influences of Chronic Pain Discovered

Despite the fact that chronic pain is one of the most prevalent health problems, the widespread treatment for alleviating it consists of non-steroidal anti-inflammatory drugs (NSAIDS), opioid analgesic drugs, anticonvulsants and antidepressants. These drugs have limited efficacy since the pain is relieved in only half the individuals receiving these drugs, that too only temporarily. 

This research aimed to identify the cellular mechanisms that regulate chronic pain in an effort to improve the currently practiced treatments. The study was carried out by scientists at Drexel University College of Medicine and was led by Melissa Manners, PhD, supervised by Seena Ajit, PhD, assistant professor at College of Medicine. The study was subsequently published in Epigenetics & Chromatin. 

Genetic Regulators of Chronic Pain Unearthed 

The researchers discovered that the DNA-binding protein methyl-CpG-binding protein 2 (MeCP2) controls the expression of various genes involved in the regulation of chronic pain. By binding to the DNA, this protein alters the expression of genes, causing considerable changes in the genetic pathways of chronic pain. 

It was discovered that this is the same protein whose mutation results in Rett syndrome, an autistic spectrum disorder that affects girls more than boys. The patients of Rett Syndrome have been found to have a higher threshold for pain which led the scientists to theorize that MeCP2 is involved in the regulation of pain perception. 

A study of the dorsal root ganglia of the spinal nerves established that injuries to the nerves can alter the way in which MeCP2 binds to the DNA which, in turn, causes changes in the genes controlling pain. Owing to the extremely small size of the dorsal root ganglia, this study was particularly difficult to perform. The level of MeCP2 was invariably found to be elevated following the nerve injuries. 

Genetic Basis of Chronic Pain 

The next big step was to pin down the specific genes that are regulated by methyl-CpG-binding protein 2 (MeCP2). For this, the scientists conducted a large scale study to recognize the pattern of binding of DNA in the dorsal root ganglia of the spinal nerves. The scientists strived to identify the sequence of DNA in the genome of mice, especially those that are bound by MeCP2 and to study the changes in these sequences after nerve injuries. 

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It was determined that after injury to the nerves, the pattern of attachment of MeCP2 moved towards the parts of DNA that code for proteins and RNA. These findings led the scientists to the conclusion that the binding of MeCP2 to the DNA is not limited to a few genes only and wide areas of the DNA are bound due to which a large number of genes are involved in the regulation of chronic pain. 

This study has proved to be a big step forward towards identifying the exact molecular and genetic mechanisms of chronic pain. Since a broad number of genes are involved in the expression of pain, it is very difficult to come up with a single drug that can affect all these genes simultaneously. However, further studies can help identify the target areas of MeCP2 which can lead to the formulation of better treatment plans. 

Spinal Cord Stimulation: An Effective Alternative to Drugs for Chronic Pain

Chronic pain is one of the leading health problems around the globe since it affects not only the patient but also leaves a significant effect on the friends and families of the patients besides exerting a substantial strain on the healthcare resources. 

A recent study has identified spinal cord stimulation as an effectual treatment method for people suffering from chronic pain conditions. Being devoid of the side effects of drugs, it has been hailed as a safe alternative to drugs for chronic pain. 

In an effort to identify better treatment plans for the management of chronic pain, a study was carried out by Australian researchers, led by Paul Verrills from the Metro Pain Group in Melbourne, Australia. The research was later published in Journal of Pain Research. The study was centered on determining the efficacy, feasibility, safety and the viability of spinal cord stimulation, also commonly known as dorsal column stimulation, as an effective method of treating chronic pain.

Routes of Spinal Cord Stimulation

During the course of the study, the researchers looked at the findings of three different studies that stipulated three distinct routes of stimulation of the spinal cord namely dorsal root ganglion spinal cord stimulation, burst wave form spinal cord stimulation and high frequency 10 (HF10) spinal cord stimulation.

The researchers stumbled upon plenty of evidence during literature review that proves the safety and efficacy of dorsal root ganglion spinal cord stimulation and high frequency 10 (HF10) spinal cord stimulation for the treatment of chronic back and limb pain. 
The researchers, therefore, concluded that back and leg pain can be safely managed using spinal cord stimulation method. One of the biggest benefits of spinal cord stimulation is that it is free of the side effects associated with other treatment strategies being practiced for chronic pain management which reduces the risk of complications. 

A number of factors affect the efficacy of this technique, including expertise of the clinician, method of patient selection, underlying cause of chronic pain, presence of co-morbid conditions, psychiatric disorders, smoking and delay in the administration of SCS. However, there is compelling evidence to establish the efficacy and safety of spinal cord stimulation for the management of chronic pain resulting from a number of painful conditions. 

Newly developed spinal cord technologies have wide-spread applicability and allow targeted and individualized treatment of the patients of chronic pain. Many previously carried out studies show that patients have experienced significant reduction in the refractory chronic pain, especially limb pain, following treatment with spinal cord stimulation technique.  This study has played a pivotal role in updating the existing literature about the role of SCS in chronic pain management. 

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Recommendations

The researchers came up with effective recommendations that can prove valuable in the treatment of chronic pain. Spinal cord stimulation was suggested as a first line treatment method instead of an end-stage strategy as the course of action to be employed for chronic pain management. This way, the deleterious side effects of the drugs like opioids, non-steroidal anti-inflammatory drugs (NSAIDS) and anti-depressants being used for chronic pain can be avoided and this debilitating condition can be managed more effectively.