New Approaches to Chronic Pain Management
Edward Mowery, who battled intense pain for years, likened his suffering to being trapped in a frying pan. The pain was so overwhelming that it forced him to give up his job, sports, and even his death metal band when it was on the verge of success.
“There was a time when I had no feeling in my arms or hands,” Mowery, 55, from New Mexico, explained. “I couldn’t play even a single note on guitar, let alone perform.”
Everything shifted for Mowery when doctors introduced a cutting-edge technique in pain management. If this method can be fine-tuned to be less invasive and shown to be effective for others, it could profoundly change how chronic pain is treated—without resorting to opioids or painkillers.
Dr. Prasad Shirvalkar, a neurologist at the University of California San Francisco, commented, “The current standard for selecting medications is basically trial and error in pain management. It’s like being your own guinea pig.” Finding a more targeted approach to stop pain signals in the brain before they manifest in the body could represent a significant breakthrough in treatment.
In the U.S., about 50 million adults deal with chronic pain, which is defined as pain lasting for more than three months. Approximately 8.5% of these individuals, like Mowery, experience chronic pain that disrupts their daily lives, according to the Centers for Disease Control and Prevention.
Mowery’s history is filled with injuries from skiing and soccer, leading to 34 surgeries overall, including 11 on his knees. The real trouble began after a routine knee replacement in 2009 when his right foot began feeling as if it were on fire.
After numerous consultations with various doctors trying to find answers—many of whom dismissed his pain as a possible addiction to opioids—he was finally diagnosed in 2017 with complex regional pain syndrome (CRPS) after seeing a specialist in Albuquerque.
CRPS is a neurological condition often triggered by surgery, injury, or other trauma. It can cause severe pain, skin changes, and abnormal blood flow. Mowery learned that his brain had essentially continued to transmit pain signals even after the initial acute pain subsided.
Doctors attempted numerous medications, including morphine and oxycodone, but Mowery felt too foggy to function normally. At one point, he was taking 17 pills a day, but nothing seemed to provide lasting relief. He eventually relied on a walker or wheelchair to get around, leading to despair about his situation.
“They should really call CRPS the suicide disease,” Mowery remarked somberly, reflecting on how hopeless he often felt.
Mowery sought out clinical trials and discovered one at UCSF that piqued his interest, even though the details were vague. After completing a questionnaire, he was urgently invited to San Francisco for further assessment.
The long-awaited relief seemed possible when doctors proposed drilling holes in his skull to explore treatment options.
Shirvalkar had long sought solutions for chronic pain. Through his endeavors, he realized many patients had failed multiple treatments, highlighting the need for innovative techniques to manage chronic pain signals generated by the brain.
He envisioned using deep brain stimulation, a method often employed for Parkinson’s disease, to redirect pain signals in patients like Mowery. However, the unpredictability of pain signals across different brains posed unique challenges. They also faced the technical difficulty of sensing when the brain was about to send a pain signal.
The research team employed computational models and AI to identify biomarkers that could signal the severity of chronic pain, much like how an A1C level indicates diabetes levels.
To test the efficacy of deep brain stimulation, Mowery would need to undergo multiple surgeries, which initially made him hesitant. Eventually, after 18 months, he acknowledged that the trial was the best route for him as his pain escalated.
The first operation involved mapping his brain to determine the source of his pain, followed by a procedure to remove temporary probes and a final one to insert permanent probes at targeted locations.
During the initial trial phase, Mowery spent ten days in the hospital, where doctors explored over 100 points on his head. They aimed to identify and stimulate specific areas related to pain. It wasn’t until the fifth or sixth day that a breakthrough happened.
“Suddenly, Ed exclaimed, ‘Wow, my pain just washed away!’” Shirvalkar recalled, still taken aback by the experience.
To ensure accuracy in their targets, the team continued testing, and they quickly became convinced they had found the right areas when Mowery reported an immediate reduction in pain throughout his body.
Shirvalkar noted that while chronic pain lacks a singular pain center, the success of this breakthrough suggests that there might indeed be a way to unlock the underlying mechanisms.
Though much research is still needed, the team recently published findings indicating that deep brain stimulation significantly reduced pain in a trial of six participants over 22 months. Mowery now enjoys more normalcy in his daily life, including playing guitar again, as he manages his brain signals through an iPad app.
While he’s not entirely pain-free and occasionally experiences bad days, those instances are far less frequent. Mowery expressed immense gratitude for the transformation in his life, stating, “I feel like I owe him my life.”
In June, he even joined Shirvalkar in Washington to discuss the NIH BRAIN Initiative’s effects on pain treatment before Congress.
Shirvalkar is understandably concerned about sustained funding in the current political landscape, echoing many researchers’ sentiments about NIH grants.
“Our funding situation is stable for now, but we must remain vigilant,” he stated.
Mowery hopes that his story exemplifies the potential for success in medical research and innovation. “I’ve been called a medical astronaut before; it’s humorous given that my sister is an actual astronaut,” he joked. “It feels like a miracle.”
