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Understanding pain in order to treat it


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Diario de Navarra

Nicolás Varela

manager from area of the Clínica Universidad de Navarra

The award Nobel Prize in Medicine 2021 for Drs. Julius and Patapoutian is a further step in understanding how our body perceives the environment in which it moves.

These discoveries continue to clarify, little by little, the way in which our senses function, following the line traced since the 17th century by the French philosopher Descartes. Understanding how we interact with the world around us through the senses is the fundamental step in being able to treat those patients who suffer from an alteration of these same essential senses.

Julius and Patapoutian's work has led to an understanding of how temperature is transmitted. David Julius used capsaicin, literally the hot part of the chili bell pepper. He applied it to healthy skin, generating a sensation of heat. He and his collaborators then created a Library Services with millions of DNA fragments, which they studied until they found the gene for the capsaicin receptor, the TRPV1 receptor.

This is probably one of the greatest milestones in pain medicine since Wall and Melzack's gate theory, which made it possible to understand that a non-painful stimulus - touch, for example - can calm pain. It can sometimes give the impression that all these discoveries concern only the theoretical knowledge , that they are of interest only to researchers and physicians. However, in the case of Julius and Patapoutian, a therapeutic line was directly opened for capsaicin as a drug for pain management, just as Wall and Melzack's gate theory had given rise to spinal neurostimulation for the treatment of chronic neuropathic pain.

It is important to remember that acute pain -that which appears suddenly- is a constant in the life of every human being. Even before we are born, we feel pain
pain, and this unpleasant sensation will accompany us throughout our lives. However, when pain is sustained over time and becomes chronic, it has no meaning whatsoever: it becomes a pathology in itself.

Over the last decades, various strategies have been applied for the treatment of chronic pain, but what we have learned the most is that a single drug, an infiltration, surgery or even implanting a neurostimulator is not enough to treat these pains. Chronic pain affects the patient as a whole, in all the different spheres of his or her life, and therefore all of them must be addressed. Of course, knowing the underlying biological and molecular mechanisms will allow us to better understand what is happening, but only in part. Understanding the patient's environment, the implication of his pain on his family and friends, the impact on the work environment, etc. are all aspects that have to be taken into account.

Therefore, for a comprehensive management of this subject of patients, it is necessary to be able to add both the basic research that allows us to understand the molecular or biological mechanism, and the applied research that allows us to develop strategies, all in an environment of clinical attendance that allows the discoveries and the research to have a real impact on the lives of all our patients.