Why Pain Is Such A Complicated Process

Pain ProteinIn the February 4, 2017 issue of Science News Magazine, there is a fascinating article about pain. There is a protein in the body known as Na.1.7 that sits on pain sensing nerves. It has been known that when it is triggered, a signal is sent to the brain that the body should feel something painful. New experiments have shown how complicated things can be in the body, as tests on rodents have shown that Na.1.7 activity also triggers production of pain relieving molecules, meaning our bodies has an ability when sensing pain to also fight pain.  

To illustrate what this might mean, it is interesting looking at those people with a nonfunctional Na.1.7 protein. These are a rare group of people who do not feel pain. It may sound like a great problem, but these individuals have great difficulty preventing themselves from getting injured. When studying these people, researchers found higher than normal levels of the body’s natural opioid compounds. Then a researcher decided to give one of these patients naloxone, the compound used to block opioids, especially when someone has a narcotic overdose. The patient suddenly felt pain for the first time.

Understanding The Complexity Of Pain

This is why pain is so complicated; the protein Na.1.7 has both pain promoting and pain relieving properties in the body. This protein seems to sit at the balance point for controlling pain sensing and pain relieving functions in the body. If the cells have nonfunctioning Na.1.7 protein, then they increase their activity in producing the body’s own opioid compounds. So if we can block the activity of Na.1.7 or turn its activity down, the body can produce its own pain killing compounds.

The effect on the body of giving opioids over time is such that the body becomes tolerant to the medications. It will take more and more opioids to produce the same level of pain relief. What that is also implying is that giving a person opioids tends to make the body probable to produce more Na.1.7 and then the body produces less of its own natural opioids. The body then is sensing more pain and is less able to fight pain. Understanding this small piece of science now seems to explain why giving patients opioid medications for a long period of time is a bad solution to control pain. Simply, giving opioids increases our pain sensitivity and lowers our own ability to fight pain.

Next Steps

The next step for pain management is to do research on Na1.7 and find out how we can use this knowledge to develop treatments for pain. It is likely that it will be difficult to find the right way to influence the activity of cells and the production of this protein. If this can be done, maybe a medication can be given that just pushes down the Na.1.7 level slightly so we can feel less pain and the body can more effectively fight pain on its own. This is not something that will happen soon, but this is one of the new discoveries that may change pain control drastically in the future.

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Thomas Cohn, MD

Interventional pain doctor helping Minnesotans manage back, neck, foot, and other pain. Board-certified in physical medicine and rehabilitation with additional board-certification in pain management from the American Board of Anesthesiology (ABA), the American Board of Interventional Pain Physicians (ABIPP) and the American Board of Pain Medicine (ABPM).

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