On the Doorstep of Personalized Care for Treating Chronic Pain?

A research team from the University of Texas at Dallas, UT MD Anderson Cancer Center, UT Health Science Center at Houston and Baylor College of Medicine reports a significant advance in understanding the source of chronic neuropathic pain in humans. The discovery has broad ranging implications including possible new targets for pain treatment, and differentiation of these targets by sex. The study examined variations in RNA expression in the dorsal root ganglia (DRG) cells of patients by sex and pain state. Applying RNA sequencing to these DRG cells provided a group of biochemical pathways that may prove useful as targets for new analgesics. Senior author Ted Price, PhD, Professor of neuroscience in UT Dallas’ School of Behavioral and Brain Sciences, commented, “Our patient cohort of 21, though it doesn’t sound like many, is huge relative to any prior human chronic pain study using RNA sequencing.” The findings were published earlier this week in the journal Brain.

A significant finding from the study is that there are differences in the sensory nerves associated with chronic neuropathic pain between men and women. In men, macrophages were the most active, while in women, neuropeptides were prominent. Jeffrey Mogil, PhD, professor of pain studies at McGill University in Montreal and a leading researcher on sex differences in pain, who was not involved in the study, remarked, "This represents the first direct human evidence that pain seems to be as sex-dependent in its underlying biology in humans as we have been suggesting for a while now, based on experiments in mice." One implication of the work, according to Dr. Price, is that a new drug for migraine that targets the neuropeptide CGRP might be effective in treating other chronic pain conditions in women. "CGRP is a key player in lots of forms of chronic pain in women, not just migraine," he noted. Of the significance of this work, Dr. Price remarked, “I think that 10 years from now, when I look back at how papers I’ve published have had an impact, this one will stick out. I hope by then that we are designing clinical trials better considering sex as a biological variable, and that we understand how chronic pain is driven differently in men and women.”

Read about the research findings and implications here and here.

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• neuropathic pain