E-MailSucheenglishdeutschTwitterYouTubeFacebook

Logo

 

When a Guardian Angel Becomes a Tyrant: New Insights in Pain Research

 

One in five Europeans suffer from chronic pain for more than six months at least once in their lives. Around ten percent of the world’s population endure chronic pain for seven years, and around 14 billion painkillers are prescribed every day. “The topic of pain research is thus not only interesting from a scientific perspective; it also has immense social significance,” said Prof. Dr. Rohini Kuner, Director of the Institute of Pharmacology at Medical Faculty Heidelberg. Around 200 visitors attended her lecture “When a Guardian Angel Becomes a Tyrant: New Insights in Pain Research” on September 24 at Stuttgart’s Mercedes-Benz Museum. This lecture was part of the “Dialogue in the Museum” series jointly organized by Daimler AG, the Mercedes-Benz Museum, and the Daimler and Benz Foundation.

“What would it be like to live a life entirely without pain – wouldn’t that be wonderful?” Kuner asked her audience. “Actually, though, we would then have medical records about as extensive as the London telephone directory: Pain is a vital protective signal that warns us of danger and protects us from injury.” Pain is a phenomenon which, like the protagonist in Robert Louis Stevenson’s novel “The Strange Case of Dr. Jekyll and Mr. Hyde,” behaves completely differently depending on the particular situation. For most people, pain is a lifelong guardian angel, but it can also take on veritably monstrous form and rule the lives of some patients like a tyrant. There are many triggers for chronic pain, Kuner continued, such as inflammation due to arthritis, or trauma and amputation. But disorders such as migraine, diabetes or cancer are also often accompanied by severe pain. “Severe, chronic pain is experienced by many people as a deep intrusion into their personality – a kind of invasion, against which they feel helpless.”

In ancient times, the idea was widespread that pain was a punishment sent by the gods for sin and wrongdoing, but this concept underwent fundamental change during the Renaissance. René Descartes postulated for the first time that the human body must contain something like paths of pain leading to the brain, and Charles Darwin attested that pain was a homeostatic function that served to preserve a species, just like hunger and thirst.

Many patients are confronted with the supposition that their pain is not properly treated, said Kuner, and an odyssey begins from one doctor to the next. Citing the example of a fictitious war veteran with a wounded leg who continues to experience extreme pain even after the wound has completely healed, she gave her audience a both rhetorically adept and scientifically sound overview of the different types of pain and their physiological causes. She explained that with some injuries, immune cells can penetrate and chronically modify the nerve tissue; this triggers hypersensitive reactions even to simple stimuli, which are then felt as chronic pain. Especially damage triggered by tissue injuries, nerve lesions, or tumors gives rise to scar-like changes at the nerve endings and thus to permanent activation, which can lead to pain memory. She also pointed out the special ion channels via which such pain stimuli are triggered. Interestingly, many of these ion channels are often also associated with a sensation of extreme heat or cold, so that it is entirely correct that some sufferers describe their pain as burning or piercing.

Great hopes, said Kuner, lie in the development of new drugs that very specifically block certain sodium channels at the nerve endings, leading to a reduction in pain without affecting the organism’s natural functions, for example those of the heart or the respiratory center. Immunological therapies, such as the application of special antibodies that have proven highly beneficial above all in cases of inflammatory pain, will likewise reach market maturity in the near future. In addition, the animal kingdom offers a whole arsenal of promising and highly potent neurotoxins, such as those of snails of the genus Conus, which provide great potential for pain suppression. Stimulation of specific areas of the brain by optogenetic light fibers is also proving successful.

“There’s a lot happening in research right now, and we’ll have some very new painkillers available within the next few years,” Kuner reported. “But it’s also significant that we physicians are now taking a more holistic view of patients, and we’re supplementing new, powerful pain therapies with elements such as physiotherapy, psychotherapy, cognitive behavioral therapy, and everyday social support. After all, these factors work closely together and help people break out of the vicious circle of chronic pain more easily and find their way back to a normal life,” Kuner concluded.

Speaker
Prof. Rohini Kuner, Ph.D., is Director of the Institute of Pharmacology at the Medical Faculty Heidelberg, where she holds the Chair of Pharmacology and Toxicology. After receiving her Bachelor’s degree in pharmaceutical technology from the University of Mumbai, she earned her doctorate at the University of Iowa (USA) and completed her habilitation at the University of Heidelberg. She has received numerous awards for her research work, and for example has been appointed a member of the German National Academy of Sciences Leopoldina.
 

Dialog in the Museum
September 24, 2019
Mercedes-Benz Museum
70372 Stuttgart

Speaker:
Prof. Rohini Kuner, Ph.D.
Heidelberg University