Customised medicine offers solution

An international team of experts has provided a breakthrough in the study of chronic pain in rheumatoid arthritis patients. “We discovered that hypersensitivity is often the cause for all kinds of chronic pain. Personalised treatment tailored to the patient offers the solution here,” says VUB professor Jo Nijs, who is in charge of the project.

Professor Nijs coordinated the study involving 17 pain experts from 13 universities in seven countries, including five researchers from VUB. They wrote an overview report of all research into chronic pain. The findings were published in the Lancet Rheumatology, a leading medical journal.

Chronic pain: a global problem

Chronic pain is the most common cause of disability worldwide, resulting in huge healthcare costs and making research into chronic pain valuable. Patients often have much more pain than the damage to their bodies would suggest. The cause of this “exaggerated” feeling of pain is central sensitisation. “In central sensitisation, the nerve cells in the central nervous system – that’s the brain and the spinal cord – are hypersensitive to stimuli,” explains Nijs. “We have known about this for some time, but only now has it become clear that central sensitisation can explain pain in a wide variety of disease states, from pain after cancer to rheumatoid arthritis and persistent pain after surgery.”

Pain in rheumatoid arthritis patients

Central sensitisation explains many forms of chronic pain. Some examples of conditions where central sensitisation has been identified:

- fibromyalgia: chronic pain in muscles and connective tissue

- pain after cancer

- pain after surgery (after a knee replacement or back surgery)

- whiplash: injury resulting from a forceful forward and backward movement of the neck

- osteoarthritis and arthritis: impairment of joints, tendons or muscles

- “hypermobile” or extremely flexible joints

- tendon disorders in the hand, wrist, arm or shoulder

- headaches

- back pain

The solution to all these forms of chronic pain is precision medicine, targeting the central nervous system when central sensitisation is present.

Tailored pain management

“Precision medicine means we can categorise patients into certain subgroups, with each subgroup receiving a different treatment tailored to the patient,” says Professor Nijs. “We can now consider patients with central sensitisation as a large and distinct subgroup, and this has major implications for the treatment of chronic pain.”

How does it work? “First, the treating physician examines the patient’s specific pain symptoms. In doing so, the presence or absence of central sensitisation should guide the content of the treatment plan. Patients with central sensitisation do not respond well to treatment directed at joints, muscles or other ‘local’ structures, such as surgery, manual therapy or certain forms of medication. Rather, these patients benefit from centrally acting medication in combination with other ways to reduce pain, such as exercise, stress management, improvement of any sleep problems and so on. Such an individual approach is the best way to give patients with chronic pain a better quality of life,” says Nijs.