Intractable Pain Management Requires Countering Spinal and Brain Inflammation

September 30, 2022

Summary: More than one-third of adults experience chronic pain, which is pain lasting for more than three months. It may be continuous or intermittent pain. However, in many, this pain progresses to so-called intractable pain, a kind of pain that outlives the underlying cause. This means that though the root cause of pain has been cured, one still continues to experience pain. Such pain does not respond well to most common pain treatment methods. Moreover, intractable pain causes neuroendocrine dysfunction, stress, mental health issues, and worsening cardiovascular health. Thus, doctors advise that treatment of such pain should not be limited to painkillers, and people must explore alternative therapies, too.

Chronic pain is one of the most significant problems faced by western society. Experts describe it as a painful condition lasting more than three months. Chronic pain may be constant or intermittent. It appears that almost 40% of people are affected by chronic pain.

Joint and musculoskeletal issues are the most common causes of chronic pain. Treating chronic pain is challenging, and it is one factor leading to opioid epidemics in the US. However, intractable pain is different from chronic pain.

It seems that sometimes, pain outlives the disease itself. Doctors are able to treat the underlying causes of chronic pain through prolonged treatment. However, many patients continue to experience pain, even after recovering from the underlying illness.

It seems that prolonged pain causes some irreversible changes in the neurocircuit, especially in the spinal cord and brain. Persistent and poorly treated chronic pain causes inflammation of the spine and even certain brain areas. This inflammation causes significant changes in the way pain signal is processed. This causes constant or intractable pain and hyperalgesia (high pain sensitivity).

Treating intractable pain is much more challenging than chronic pain. Doctors define intractable pain as something whose cause cannot be removed. It means that they have a poor understanding of how to provide prolonged relief. Such kind of constant pain causes much distress, resulting in much wider changes in the body, including endocrinal changes.

Thus, those living with chronic pain must understand that intractable pain differs. It is a pain that often outlives the condition that initially caused it, and doctors find it challenging to treat. It is a pain that can be managed but not cured.

Intractable pain causes significant changes in the brain, resulting in abnormal levels of various neurotransmitters like dopamine, GABA, endorphins, serotonin, and more. Correcting these imbalances is a challenge for modern medicine2.

Constant pain causes many other changes in the body, like fatigue, lack of motivation, attention deficit, significant changes in cardiovascular health, high blood pressure, memory impairment, social withdrawal, changes in appetite, weight gain, and even depression.

As one can understand, intractable pain is not just about pain most of the time, as it has much broader adverse health effects. It is now sometimes called “intractable pain disease.” As there are many changes in the body, and if the condition is not treated, it may cause severe neuroendocrine dysregulation due to spinal and brain inflammation.

Intractable pain often requires the prescription of opioids. However, now researchers warn that people living with such pain should also explore other treatment modalities, as the use of painkillers is not enough.

For example, if intractable pain starts due to conditions that end with “itis,” like arthritis, cystitis, colitis, or myositis, then one would require anti-inflammatory treatment and even regular use of corticosteroids.

However, many of these drugs have significant adverse effects. Thus, experts recommend exploring alternative treatments like cannabidiol (CBD), Boswellia, Ashwagandha, turmeric/curcumin, and more.

Experts say that people living with intractable pain must avoid relying on painkillers alone. Moreover, it is no secret that such difficult-to-treat pains do not respond well to painkillers, as painkillers like opioids do not treat the underlying cause.

Moreover, the cause of intractable pain is still not fully understood, and researchers think only a broader approach to health and wellness may help alter spinal and brain inflammation and help handle broader physical changes caused due to constant stress.

One should pay particular attention to lowering stress response and low-grade inflammation and focus on normalizing the cardiovascular stress response. One would also need to manage mood disorders and other more severe neurological and mental health conditions.

By Gurpreet Singh Padda, MD, MBA, MHP