Growing pain

Holden Thorp

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This month, Science Translational Medicine published a special issue laying out the main issues in pain research, the biological and psychological mechanisms of pain, and research on treating chronic pain.

America’s opioid crisis has placed the issue very much in the public eye, most recently because of the legal proceedings against members of the Sackler family, their company Purdue Pharma, and the highly addictive painkiller OxyContin. As chronicled in the book Empire of Pain, released earlier this year, OxyContin was irresponsibly pushed to the public, leading to hundreds of thousands of deaths and many more lives ruined. And the recent Hulu series Dopesick provides a riveting account of the devastation wrought by the drug.

This story provides another example of how some scientists failed to behave in a principled manner. The scientists who developed the pill—even those who knew the danger—didn’t come forward until far too late. The US Food and Drug Administration ignored warnings and destigmatized opioids, most likely because the agency was enticed by the idea that a pill could reduce the suffering of millions with chronic pain. As trust in science continues to erode among parts of the public, failures in the opioid crisis have given detractors more reasons to doubt scientists and their commercial partners.

Unfortunately, science is still coming up short with solutions to chronic pain. Even after a hundred years of study and research, there is no treatment that doesn’t come with a high risk of addiction. Will pain always defy a medical solution? If so, then scientists need to cede the treatment of pain to mental health professionals. Otherwise, if science can find a solution, we need to try even harder because there are millions of cancer patients and people at the end of their lives who deserve a path out of their suffering.

As the Science Translational Medicine compendium shows, the scientific community is still focused on the biochemical approach to chronic pain, but this commitment must be paired with communication and policy that avoids another opioid disaster.

At the end of Dopesick, Michael Keaton’s character—a doctor who gets addicted to OxyContin but eventually finds a way to help addicts in his community—makes a powerful speech about pain:

“Pain is just pain,” he says. “Not good, not bad. Just part of being human. And sometimes good can come out of it. And if we’re brave enough, willing to go a little deeper, work our way through it, try to overcome it; well, we just might find our better selves.” 

Science needs to find its better self on the issue of pain. It needs to own up to its failures and redouble efforts to define the problem of chronic pain and assess whether a biochemical solution is feasible or not. 


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