A new gift to ease pain
Date: November 21, 2011
Pain: It’s a universal phenomenon that’s as old as time, and people have been working nearly as long to treat it. Sometimes it’s a true warning that something is amiss in the body, as in the agony of appendicitis or the sting of a scraped knee. But often, pain occurs through a glitch in the body’s wiring—a problem in the systems that sense, transmit or process painful sensations. This neurological type of pain can be excruciating, as well as extraordinarily difficult to effectively treat.
It’s better than it used to be, explains Henry Brem, Harvey Cushing Professor and director of the Department of Neurosurgery. In the past several decades, advancements including new pharmaceuticals, novel spine and peripheral nerve surgery, and high-tech treatments such as deep brain stimulation have revolutionized how pain is treated. However, he notes, sometimes these therapies simply aren’t enough for patients to live a normal life.
“Even very experienced doctors and nurses feel powerless sometimes with helping patients,” says Brem’s colleague Bobbie Norris, a pain resource nurse in the Department of Neurosurgery. “You try as much as possible to get their pain relieved, and sometimes you just can’t.”
Unmanageable pain doesn’t just affect patients’ comfort, she adds. Pain impacts nearly every aspect of their hospital stay and recovery. It can color the flavor of food and make ambient noise, such as a housekeeper emptying the trash, nearly unbearable. Pain can also prevent patients from participating in their care. “They can’t attend physical or occupational therapy as often, or at all,” Norris says. “They may not get up and move, so they might develop respiratory or gastrointestinal problems.”
Though pain can be challenging to treat, Brem, Norris and their neurosurgery colleagues believe it’s not an impossible task. However, better understanding of how the body and brain modulate pain, as well as more research into the best ways to treat patients with available resources, could improve pain treatment far beyond what current resources allow.
With the aid of a $25 million gift as seed money, the Department of Neurosurgery has established the Neurosurgery Pain Research Institute at Johns Hopkins - To Control, Prevent and Eliminate Pain, a name carefully and thoughtfully chosen by the donors. It was important to the donors to let others know exactly what the institute is planning to accomplish, and thus they wanted it to be evident in the name.
“It’s a transformative gift that will change the way neurosurgical pain is understood and treated,” Brem says.
One of the programs this gift is already funding is a pain team, led by Norris, that sees every neurosurgery patient to evaluate his or her pain and develop a comprehensive treatment plan. Sometimes the fix may be as easy as reconciling a patient’s home medication list to what’s being prescribed in the hospital. Other times, Norris says, doctors, nurses and pharmacists work together to make sure patients are receiving adequate amounts of pain-relieving medicines.
The new gift is also funding research that could potentially revolutionize how pain is treated. For example, one project funded by the new institute is looking at one of pain’s most pivotal players: the brain, which processes and perceives painful nerve signals. Frederick Lenz, A. Early Walker Professor of Neurosurgery and director of epilepsy surgery, notes that previous research has identified several brain areas that are active when people perceive pain. However, it’s been unclear whether all these areas are essential for pain sensation.
Lenz and other researchers believe that the truly active areas operate in a network, with the direction and amplitude of activity transmitting specific information about pain necessary for perception. He speculates that if they can interrupt this network—perhaps through electrical stimulation to specific parts of the brain—they may be able to eliminate some patients’ intractable pain. The new funds are helping Lenz and his colleagues bring their work into real applications.
“We can now do those studies that can make these theories into a practical reality,” he says.
Eventually, caregivers and researchers at the institute may be able to make uncontrolled pain a distant memory, says Norris. “As Pollyanna as it sounds,” she says, “we would love to have a pain-free world.”
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