Randall H. Duckett

Fresh research into the causes of and treatments for enduring hurt make me optimistic that the future will bring relief

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Chronic pain is a bitch.

It takes over lives and leaves sufferers desperate for relief.

In cases like fibromyalgia, chronic fatigue syndrome (CFS), and complex regional pain syndrome (CRPS), pain may be invisible and apparently without cause, leaving some to question whether it is real. It can cause relationship problems, family tension, and career disruption. It whipsaws sufferers through an array of emotions, including grief, loneliness, and depression.

Most of all, chronic pain leaves sufferers feeling hopeless.

As a chronic pain sufferer myself, I am no stranger to these complex feelings. 

Over the past couple of years, I’ve written hundreds of thousands of words about chronic pain, ranging from telling personal stories about my own experience, like accepting my pain (see chapter 36), to talking about big subjects, like the opioid crisis (see chapter 18).

Now, as I write this in 2025, I’m taking stock of where sufferers like me stand. Though our situations feel dire, I actually have hope that new trends and technology mean we will find future relief. I see progress in how chronic pain is diagnosed, treated, and thought about. As I look at the latest pain news, I found some hopeful developments:

Researchers are finding the root cause of chronic pain

Chronic pain is wily.

In some cases, there is a direct cause, something to be treated like a bum knee. In many, though, there are questions as to what prompts it. It may move throughout the body, camping in different places on any given day, at any given moment. It may be a frustrating mystery, a what-done-it?

The exact mechanism of chronic pain is still unknown, but researchers are homing in on the possible roots of how it works. Acute pain is tied to damage to the body; the chronic variety is more puzzling.

Recent research conducted by the University of Aberdeen, Scotland, Academia Sinica in Taiwan, and other international experts showed chronic and acute pain are physiologically distinct — that is, two different conditions in the body. This realization clears up confusion about whether chronic pain is just an extension of acute pain or, as researchers discovered, a disease with its own mechanism.

Scientists are identifying the root causes of chronic pain. A breakthrough study, for example, reported that neuron overactivity in the brain stem could be the source. In ordinary circumstances, these neurons put the brakes on acute pain, sparing a person from the worst hurt. With chronic pain, though, the brakes don’t work, prompting an ongoing, out-of-control pain response. This discovery might lead to treatments that restore the body’s natural defense system.

Other researchers are working on the theory that some kind of chronic pain could be an autoimmune condition in which the immune system attacks the body. And scientists from Stanford University identified “zombie” cells (old dormant cells that build up with age) as a possible source of pain. Targeting the Walking Dead cells with drugs may relieve, or at least help manage, age-related diseases like arthritis, Alzheimer’s, and Parkinson’s.

The more we know about the true source of pain, the better it can be treated.

Scientists are uncovering pain biomarkers

One of the most vexing problems with treating chronic pain is that it is often invisible, biologically speaking. Right now, physicians can only quiz patients about their pain and ask them to assign a number from 0 (for no pain) to 10 (for the worst pain imaginable). This is inherently subjective (see chapter 21). It makes providers nervous because they cannot see the problem under a microscope, in a blood test, or with imaging.

Progress is also being made, however, on the Holy Grail of chronic pain: a biomarker that objectively shows whether a person has pain and how bad it is.

In one study, computer learning (read AI) was used to try to use health data to tell the difference between people with pain and those without. It was able to identify pain patients with about an 80% accuracy rate, which is a step toward more objectively diagnosing chronic pain.

Other researchers have reported that alterations in muscle tissue may signal back pain. One study reinforced the idea that there are microbiome “signatures” for such conditions as postoperative pain, arthritis, neuropathy, migraine, fibromyalgia, and CRPS.

Yet another study compared patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to those without symptoms. As reported in Harvard Health, it found “abnormalities involving the brain, immune system, energy metabolism, blood vessels, and bacteria in the gut.”

So overall, I’m encouraged that science is making progress in identifying pain via biomarkers. Thus, chronic pain is becoming more “real” and less likely to be dismissed as a phantom disease.

The opioid crisis is easing

The opioid crisis is a scourge that has caused many societal problems, including 645,000 overdose deaths from 1999 to 2021.

A less noticed issue is that the opioid crisis has been conflated with the chronic pain epidemic in the public mind (see chapter 18). Legitimate chronic pain sufferers endure a severe stigma (see chapter 33) against those who need such medicines for pain relief. Deaths from opioids have been used as an excuse to set severe restrictions on opioid supply from pharmaceutical companies, artificially limiting what and how much medicine chronic pain patients can get.

Recently, though, there is some encouraging news. Overdose deaths attributed to opioids have plunged. In 2024, an estimated 80,391 people passed away, an approximately 27% drop from the year before and much less than a previous peak of 115,000 annually.

No one is sure exactly why this happened or whether it will last. Some speculate that increased intervention — particularly the widespread availability of overdose-curing naloxone (brand name Narcan) — and law enforcement efforts are working. Cynics say that those who are most vulnerable have already died and there are fewer at risk.

Still, while 80,000 is a huge human toll, particularly for their families, the stats are trending in a positive direction, and not just because fewer people are dying. Another positive step is that the hysteria around fentanyl and other opioids may wane. This could help sufferers who need these medications, but who are afraid to ask for them because they fear being labeled addicts.

I’m hopeful that policymakers will finally recognize that the tens of millions of us in chronic pain can benefit from legally prescribed drugs (see chapter 7). And I hope that physicians will be mostly left alone to do their jobs in the best interests of patients, without fear they will be arrested or sued for providing appropriate care for people in chronic pain. I hope that artificial restrictions on the supply of legal medications become eased, particularly since restricting supply has likely done little to solve the problem. I do not advocate decriminalizing illicit opioids, but I do believe we as a society should take a more mature approach to providing legal medicine to the millions of people like me who need it. I’d like some grace to let us get the medicine we need to feel better.

Chronic pain treatments are becoming more individualized

Someone told me: “There’s not going to be a penicillin for pain.”

Some researchers (particularly those working for pharmaceutical companies) are seeking a silver bullet for chronic pain, but because pain is so diverse, they are unlikely to find one. Instead, doctors and other providers should focus on individualized care, on treating each pain patient as unique and tailoring treatment to each.

This includes keeping up with the latest research about how different people feel pain.

For example, a study reported the journal PNAS Nexus in 2024 found that men and women experience pain differently, opening the door for gender-specific treatments. A greater percentage of females report chronic pain than males, yet they are more likely to be dissed, dismissed, and gaslit (see chapter 19) by the healthcare system.

Other research has found disparities in how pain is treated based on race and ethnicity. It concluded that non-Hispanic Black and Hispanic patients got fewer referrals to specialist care and lesser opioid prescription rates as compared to non-Hispanic white people. And a study found that though Asian people in the US generally report less chronic pain, that pain gets worse when the person is a victim of discrimination and prejudice.

Increasingly, those who treat pain are asked to take a varied, multifaceted approach to care. Some have called this “deconstructing the cupcake,” a clumsy attempt to say that one-size-fits-all solutions usually don’t work and care should be broken down into more manageable pieces like physical therapy, medication, psychological therapy, and lifestyle changes (like not gobbling cupcakes).

Penicillin for pain is not coming, but I’m optimistic that customized care can make a difference.

Brain plasticity is being recognized

Chronic pain is a tango between how one thinks and the pain he or she feels.

The physical influences the mental and the mental influences the physical, in a constant feedback loop.

In keeping with individual medicine, this means that chronic pain should be addressed in a “biopsychosocial” way (see chapter 26). The “bio” refers to the physical. The “psycho” (which sparks memories of a Hitchcock movie) refers to the mental. The “social” refers to the relationships and environment a patient lives within.

Yes, treating the physical is important, but pills, injections, or operations alone won’t completely relieve the problem of chronic pain. The other factors that go into it must be considered.

Traditional medicine’s “this-hurts-so-fix-it” quest is too simplified for chronic pain. Most doctors want a clear problem to solve; they become flummoxed when it appears there is nothing to be done with a drug or surgery. 

And no wonder: Most mainstream docs get little education about pain. Plus, addressing all the facets of pain is involved and expensive, as opposed to embracing quick fixes like prescribing antibiotics.

It turns out that the ways one thinks about his or her pain can increase or decrease its severity. For example, catastrophizing pain makes it worse, and using interventions like pain education make it better. Chronic pain is partly a conditioned response, like Palov’s salivating dog, that can be modified.

The brain is where pain is processed and perceived. It can determine if pain is terrible or tame. Because of the brain’s “plasticity,” it can create pain or take it away (see chapter 15). Altering both conscious thinking and conditioned responses is a promising new avenue for relieving chronic pain.

New pain treatments are on the horizon

Physicians are fairly limited in terms of what they can do to address chronic pain. They can send patients to physical therapy. They can prescribe medications; acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) are the first line of defense, although taking them long term can sometimes damage the kidneys or liver. On the other end of the spectrum are opioids such as fentanyl and morphine, which carry a well-publicized risk of addiction and overdose. They may also use drugs targeted to nerve pain like gabapentin (though recent research associates it with a greater chance of developing dementia). Physicians can also recommend invasive interventions such as injections, implants, or operations. These can lead to a lot of pain in and of themselves.

Fortunately, doctors’ toolboxes are about to expand.

In early 2025, the Food and Drug Administration (FDA) approved suzetrigine (brand name Journavx) as a new way to treat pain. This is important because it comes from the first new class of nonopioid medications in decades. It targets pain pathways involved with sodium channels in the peripheral nervous system, before pain gets to the brain. Right now, suzetrigine is approved only for acute pain, but similar drugs may be developed for chronic pain.

Elsewhere, a number of new approaches to treat chronic pain are coming.

Duke University, for example, is working on using adenosine, a natural compound in humans, to help manage pain, inflammation, and seizure activity. The University of Buffalo created a new molecule that acts like a targeted anesthetic for up to three weeks without the numbing effects of traditional painkillers. Dalian University of Technology announced that it invented a wearable film that automatically regulates the delivery of heat to painful areas, like a smart Salonpas pad. In other materials news, the folks at Texas A&M have invented a malleable material that can be used for implants that relieve pain versus the rigid ones used now.

The bottom line

Innovation is happening in plenty of areas involving chronic pain, for individual pain conditions and for it as a distinct disease.

It may take years for some of these discoveries and inventions to be commonly used, but they are on the horizon.

My bottom-line message: Don’t give up. There are good reasons to hope for relief.

 

Pain Points

“Unfortunately, I am on many pain groups where even the mere suggestion of [brain retraining] gets people downright indignant. [They think] that doctors are saying it’s ‘all in their head’ and won’t even try [it], when it’s just another tool for our toolbox. … The brain is such a powerful thing. What we focus on truly makes a difference.” — Some days, My mind spills words…I’m Cindy

“When I started my pain journey it was due to an extremely needed hysterectomy. No one wants to believe a 20- to 27-year-old (yes it took 7 years) to have this organ removed. My doctor said the day after surgery ‘not to be a hero; ask for pain meds when I needed them.’ … I told him this was the best I had felt in years. His response was, ‘Wow you were in pain.’ And life was great for four years until lupus crept in. It does really suck that you aren’t believed. [People say] ‘You just want drugs.’ No, I would give anything not to need them and I certainly don’t ‘want’ them. I truly am of the belief that chronic pain and autoimmune conditions are caused by trauma. I look forward to the day medicine finds a genetic marker or mutation that can be manipulated.”
— Bailys Human

“[Healthcare providers are] not asking the right question. Ask, ‘Why is the pain there in the first place?’ This gets to the root of the problem. Repressed emotions [manifest] as physical pain until they’re addressed. The pain will keep presenting and moving throughout the body to keep us distracted from doing the emotional work. Simple knowledge of this syndrome usually heals or brings immediate relief.”—Brian M

Pain Points are comments on this essay as it appeared originally on Medium.com. They are solely the opinions of the commentators and do not necessarily reflect the views of the book author or publisher.