[{"command":"openDialog","selector":"#drupal-modal","settings":null,"data":"\u003Cdiv id=\u0022republish_modal_form\u0022\u003E\u003Cform class=\u0022modal-form-example-modal-form ecl-form\u0022 data-drupal-selector=\u0022modal-form-example-modal-form\u0022 action=\u0022\/en\/article\/modal\/7171\u0022 method=\u0022post\u0022 id=\u0022modal-form-example-modal-form\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cp\u003EHorizon articles can be republished for free under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence.\u003C\/p\u003E\n \u003Cp\u003EYou must give appropriate credit. We ask you to do this by:\u003Cbr \/\u003E\n 1) Using the original journalist\u0027s byline\u003Cbr \/\u003E\n 2) Linking back to our original story\u003Cbr \/\u003E\n 3) Using the following text in the footer: This article was originally published in \u003Ca href=\u0027#\u0027\u003EHorizon, the EU Research and Innovation magazine\u003C\/a\u003E\u003C\/p\u003E\n \u003Cp\u003ESee our full republication guidelines \u003Ca href=\u0027\/horizon-magazine\/republish-our-stories\u0027\u003Ehere\u003C\/a\u003E\u003C\/p\u003E\n \u003Cp\u003EHTML for this article, including the attribution and page view counter, is below:\u003C\/p\u003E\u003Cdiv class=\u0022js-form-item form-item js-form-type-textarea form-item-body-content js-form-item-body-content ecl-form-group ecl-form-group--text-area form-no-label ecl-u-mv-m\u0022\u003E\n \n\u003Cdiv\u003E\n \u003Ctextarea data-drupal-selector=\u0022edit-body-content\u0022 aria-describedby=\u0022edit-body-content--description\u0022 id=\u0022edit-body-content\u0022 name=\u0022body_content\u0022 rows=\u00225\u0022 cols=\u002260\u0022 class=\u0022form-textarea ecl-text-area\u0022\u003E\u003Ch2\u003EWhy do people develop chronic pain?\u003C\/h2\u003E\u003Cp\u003EBurning, aching, stabbing, shooting, throbbing \u2013 there is no shortage of words used to describe pain, and for \u003Ca href=\u0022https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16095934\u0022 target=\u0022_blank\u0022 rel=\u0022noopener noreferrer\u0022\u003Eone in five\u003C\/a\u003E of us, it is a persistent problem. New research, however, including the discovery of a skin organ that signals pain, could lead to better ways to treat the condition.\u003C\/p\u003E\u003Cp\u003E\u2018Chronic pain is very disabling \u2013 it affects every aspect of your life. You can\u2019t sleep, it affects your personal life, it interferes with your work, and it can often lead to mood disorders, such as depression or anxiety. It\u2019s a very disabling condition,\u2019 said Professor David Bennett, an academic neurologist at the University of Oxford, UK.\u003C\/p\u003E\u003Cp\u003EHe regularly sees patients in his clinics with neuropathic pain, which is caused by damaged nerve cells. It is a common problem, one that we are likely to see increase with an ageing population. Not only do our nerves become more prone to damage with age, but they can be harmed by conditions such as diabetes, or the side effects of treatments such as chemotherapy.\u003C\/p\u003E\u003Cp\u003EProf. Bennett is the lead coordinator of the \u003Ca href=\u0022https:\/\/cordis.europa.eu\/project\/rcn\/193238\/factsheet\/fr\u0022 target=\u0022_blank\u0022 rel=\u0022noopener noreferrer\u0022\u003EDOLORisk\u003C\/a\u003E project, a study across nine countries investigating the different factors that influence a person\u2019s risk of chronic neuropathic pain.\u003C\/p\u003E\u003Cp\u003E\u2018We don\u2019t know why some people get neuropathic pain and some don\u2019t. If we can understand that, we could reveal mechanisms that might be amenable to treatments,\u2019 said Prof. Bennett.\u003C\/p\u003E\u003Cp\u003EThe study has recruited over 10,000 patients, the largest neuropathic pain cohort ever gathered. The size of this group gives the researchers the statistical power to look at factors ranging from social class and gender to genetics and psychology.\u003C\/p\u003E\u003Cp\u003EThe analysis for the study is still ongoing, but they\u2019ve already found some associations, including genetic variations that may change the way that sensory nerves work and psychological factors.\u003C\/p\u003E\u003Cp\u003E\u2018It\u2019s early days, but the data so far shows that if you have a pre-existing mood disorder then you\u2019re more likely to develop neuropathic pain,\u2019 said Prof. Bennett. \u2018I think that some of the risk factors we\u2019re looking at are likely to be common across different conditions. My gut feeling is that it will include some of the psychological variables.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Cblockquote class=\u0022tw-text-center tw-text-blue tw-font-bold tw-text-2xl lg:tw-w-1\/2 tw-border-2 tw-border-blue tw-p-12 tw-my-8 lg:tw-m-12 lg:tw--ml-16 tw-float-left\u0022\u003E\n \u003Cspan class=\u0022tw-text-5xl tw-rotate-180\u0022\u003E\u201c\u003C\/span\u003E\n \u003Cp class=\u0022tw-font-serif tw-italic\u0022\u003E\u0026#039;Chronic pain is very disabling \u2013 it affects every aspect of your life.\u0026#039;\u003C\/p\u003E\n \u003Cfooter\u003E\n \u003Ccite class=\u0022tw-not-italic tw-font-normal tw-text-sm tw-text-black\u0022\u003EProf. David Bennett, University of Oxford, UK\u003C\/cite\u003E\n \u003C\/footer\u003E\n\u003C\/blockquote\u003E\n\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003ESignalled\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003EPart of the difficulty in understanding the variation between patients is that we still don\u2019t understand enough about how chronic pain is signalled in the body.\u003C\/p\u003E\u003Cp\u003E\u2018Pain is something you feel in the brain,\u2019 said Professor Patrik Ernfors from Karolinska Institutet in Sweden. \u2018We want to understand what kind of cells are involved in initiating pain.\u2019\u003C\/p\u003E\u003Cp\u003EProf. Ernfors is leading the \u003Ca href=\u0022https:\/\/cordis.europa.eu\/project\/rcn\/211283\/factsheet\/it\u0022 target=\u0022_blank\u0022 rel=\u0022noopener noreferrer\u0022\u003EPainCells\u003C\/a\u003E project, which is shining a light on the mysterious processes that transmit pain.\u003C\/p\u003E\u003Cp\u003E\u2018We have already discovered a new cell type, which was previously thought to be involved only as a supporting cell of the nervous system. We saw these odd-looking cells which had not been described before. They form a mesh-like network in the skin, and we were intrigued by the way that these cells look,\u2019 he said.\u003C\/p\u003E\u003Cp\u003EProf. Ernfors\u2019 team used a technique known as optogenetics to test the roles of these supporting cells. They bred genetically modified mice so that the cells were activated by blue light.\u003C\/p\u003E\u003Cp\u003E\u2018When we shine light on the skin, we activate the supporting cells,\u2019 said Prof. Ernfors. These activated cells then sent a signal through the nerves \u2013 showing that they\u2019re connected directly \u2013 eliciting pain.\u003C\/p\u003E\u003Cp\u003E\u2018We also did the reverse \u2013 when we turn these cells off, we reduce pain sensitivity,\u2019 said Prof. Ernfors.\u003C\/p\u003E\u003Cp\u003EThe network of cells in the skin form an entire organ designed for nociception, which is the response to harmful irritation. A system of cells like this in the skin has been known about for 150 years for non-pain sensations, such as touch and pressure.\u003C\/p\u003E\u003Cp\u003E\u2018But throughout all these years, pain has been thought to be special because it does not start from a sensory nerve organ. Our findings now show that there is a sensory end organ for pain and it is actively contributing to the sensation of pain,\u2019 said Prof. Ernfors.\u003C\/p\u003E\u003Cp\u003E\u2018It\u2019s been a big surprise. It\u2019s something that\u2019s conceptually new and could explain why many compounds have failed to work in clinical trials. If we can prove that they are involved in chronic pain, it will open new possibilities for treatments.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Cfigure role=\u0022group\u0022 class=\u0022@alignleft@\u0022\u003E\n\u003Cimg alt=\u0022Scientists have discovered a network of pain-sensing cells (red) in the skin. Image credit - Laura Calvo\u0022 height=\u0022329\u0022 src=\u0022\/research-and-innovation\/sites\/default\/files\/hm\/IMCEUpload\/sox10tom-dapi-key_blacck3.jpg\u0022 title=\u0022Scientists have discovered a network of pain-sensing cells (red) in the skin. Image credit - Laura Calvo\u0022 width=\u0022629\u0022\u003E\n\u003Cfigcaption class=\u0022tw-italic tw-mb-4\u0022\u003EScientists have discovered a network of pain-sensing cells (red) in the skin. Image credit - Laura Calvo\u003C\/figcaption\u003E\n\u003C\/figure\u003E\n\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EMap\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003EThe project is aiming to create a map of all the cells that are involved in chronic pain disorders, one cell at a time. Using the genetically modified mice, Prof. Ernfors\u2019 team have developed a system where the active nerves are triggered to glow so that they can be seen under a microscope.\u003C\/p\u003E\u003Cp\u003EThis means that the team can take out single cells and analyse them individually. They can find exactly which genes are active in each cell and identify similar cell types.\u003C\/p\u003E\u003Cp\u003EProf. Ernfors is now working to compare the map from mice to one created using tissue from monkeys. This will help to understand how closely the findings will relate to humans.\u003C\/p\u003E\u003Cp\u003E\u2018It\u2019s important to understand the cellular basis for pain because if you know what cells are involved in what disorder, then you also know the molecular composition of that cell. You can use that to have a rational strategy to treat that pain disorder,\u2019 said Prof. Ernfors.\u003C\/p\u003E\u003Cp\u003EThis is a challenge that Prof. Bennett is very familiar with: \u2018The (existing) treatments are not as effective as we\u2019d like. We\u2019d often need to give a drug to seven or eight patients for one to see a significant benefit.\u2019\u003C\/p\u003E\u003Cp\u003EHe describes the current approach as \u2018empirical\u2019, testing the different treatments in turn to see what works for each patient. For the patient though, that means until they find the right medication, not only is the pain still an issue but the side effects of the powerful drugs take their toll. Prof. Bennett hopes that research will help to make treatment options more rational.\u003C\/p\u003E\u003Cp\u003E\u2018One of the goals for modern pain research is to understand the mechanism that is driving the pain in individual patients. If we can tease that out, then ultimately we can try to optimise treatment for that patient,\u2019 he said. \u2018In the end, we want to target the drugs we have better, so we\u2019re giving the right drug to the right patients who are most likely to respond in the right way.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Cdiv class=\u0022moreinfoblock\u0022\u003E\n \u003Ch3\u003ETypes of pain\u003C\/h3\u003E\n \u003Cp\u003E\u003Cstrong\u003EAcute pain\u003C\/strong\u003E is sudden, short-term and usually caused by injury. When you hurt yourself, receptors known as nociceptors send a signal to the brain, which is interpreted as pain. Acute pain disappears within 30 days or when the injury has healed. Referred pain can sometimes happen when the pain sensation from one part of the body is felt in another.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EChronic pain\u003C\/strong\u003E is defined as pain that lasts longer than it should, usually longer than six months. The pain sensation continues after the healing process is complete or the stimulus is removed. The causes of chronic pain vary from injury and disease to musculoskeletal problems, such as arthritis. Some causes are still not completely understood, as is the case with migraines and fibromyalgia. Chronic pain often involves so-called neuropathic pain, otherwise known as nerve pain.\u003C\/p\u003E\n\u003C\/div\u003E\n\u003C\/p\u003E\u003Cp\u003E\u003Cem\u003EThe research in this article was funded by the EU. 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