Volume 5 Issue 2
Page 5
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Translational Pain Research at the Brigham and Women's Hospital: Help for People with TM who Suffer from Pain Christine Sang, MD, MPH is an Assistant Professor at the Harvard Medical School and the Director of Translational Pain Research at the Brigham and Women's Hospital in Boston, Massachusetts. She serves on the Board of Directors to the American Pain Society, and is a Founder and serves on the Steering Committee of the Neuropathic Pain Institute. She also serves on the advisory board committees of several companies that develop new drugs for pain, and is a consultant for the FDA on the treatment of pain syndromes Dr. Sang and our research team work together to bring laboratory research into a safe and effective clinical research setting. The primary aim of our ongoing research is to systematically evaluate new drugs for pain and to determine the cause of different types of pain to improve therapy. Our overall goal is to relieve each person's pain experience, which we hope will ultimately improve quality of life. The focus of our research group is spinal cord pain following injury, infection, or inflammation, including transverse myelitis. We realize that people suffer from severe pain which can prohibit them from everyday activities. With each person, pain varies in its intensity, frequency, and duration of episodes, as well as in overall sensations. This pain can be at its best annoying, and at its worst, nearly unbearable. Although there are many types of pain, there are two broad categories that distinguish the mechanisms of pain: mechanical pain and neuropathic pain. Mechanical pain is caused by overuse and subsequent damage to normal tissues; such as bones, joints, and muscles. It often becomes worse with movement, and eases with rest. This pain usually responds well to existing pain treatments, such as narcotics and NSAIDS (i.e., ibuprofen), and will often go away when the body heals or when the problem is removed. There are numerous medical and surgical conditions that may cause neuropathic pain. Damage to peripheral nerves can also lead to neuropathic pain, but is often easier to treat. The conditions that may cause neuropathic pain include:
Central pain can be caused by damage to the spinal cord. In essence, the spinal cord and the brain interpret otherwise normal sensations as pain. Central pain can be described in many ways -- burning, electric, tingling, shooting, stabbing, numbness, aching, throbbing, or squeezing. It can be very difficult to relieve. The responses to currently available pain treatments are often limited by side effects - such as drowsiness, dry mouth, and dizziness. The side effects and lack of adequate analgesia are frustrating for both the patient and physician. Central pain may occur at the level of injury due to damage to the nerve roots, as well as to the spinal cord itself. Doctors and other health care professionals may refer to this as "girdle zone pain." This pain follows a band-like pattern, such as circumferentially from the stomach around to the back. Central spinal cord pain may also occur everywhere below the level of injury, even if the entire cross-section of the cord is not damaged. This pain is often made worse with light touch or cold. Central pain, like chronic pain in general, may begin at the time of injury or develop slowly over months or years. It can persist for long periods of time, and interfere with one's quality of life. According to some reports, as many as 90% of people with SCI have had chronic pain. Unfortunately, central pain does not usually respond well to narcotics (e.g., morphine). On the other hand, the pain can respond to neuropathic pain medications (e.g., certain anticonvulsants or antidepressants). Some physicians recommend nerve root blocks that will numb the painful areas. This numb effect only lasts a short time and returns to baseline. Sometimes, a surgical procedure such as DREZ (dorsal root entry zone), rhizotomy, or cordotomy is recommended, although these procedures may result in yet another (secondary) spinal cord pain syndrome. As neuropathic pain can be intermittent or constant, localized in one specific region or affecting the entire body below the level of injury, our research aims to treat the specific mechanisms believed to cause central pain, rather than merely masking the pain. Our study evaluates new drugs, as well as new methods of delivering conventional drugs, that can hopefully reduce chronic central spinal cord pain with fewer side effects than currently available medications. We usually have multiple studies going on simultaneously and we are always looking at new therapies and different ways to relieve neuropathic pain. The Translational Pain Research Program at the Brigham and Women's Hospital in Boston is committed to working with people with TM and the other neuroimmunologic disorders to find an effective approach to treating pain. Our funding sources have included the Paralyzed Veterans of America, The Christopher Reeve Paralysis Foundation, and the National Institute of Neurological Disorders and Stroke (National Institutes of Health). Our program will work with patients and will also consult with and work with your physicians. We will continue working with you until the goal of relieving your pain is achieved. For more information, please contact us: Kate Jenkins, B.A., Program Coordinator Leah McInerney-Killion, R.N., B.S.N., Lead Study Nurse Kristie Chin, B.S. Study Coordinator Aparna Sarin, M.D., M.P.H. Research Fellow Karen Wang, B.A, B.S, Research Assistant Christine Sang, MD, MPH, Principal Investigator Translational Pain Research Office (617) 525-7246, http://www.mgh.harvard.edu/paintrials
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