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8th July 2015

Learning about chronic pain from Jennifer Aniston

In her award-winning role as Claire in the movie Cake, Jennifer Aniston plays a painkiller-addicted mum who’s lost her son in a car crash that’s left her in agonising pain. The emotional suffering from her son’s death will be with her forever, but could she have done anything differently to ease her physical pain?

Chronic pain affects one in five adults across Europe and more than 1.5 billion people worldwide, but it remains largely undertreated and misunderstood. Each person’s pain story is unique, which means doctors really need to tailor treatment to the patient depending on his or her needs. This could include anything from painkillers to acupuncture to physiotherapy to spinal cord stimulation (SCS)…or all of these. As sleep problems and depression are closely interconnected with the pain, these have to be managed, too. In other words, it’s complicated.

In the film, pill popping and regular visits to the physiotherapist don’t seem to have much impact on Claire’s physical recovery, and she struggles to do things that most people take for granted like sitting upright in a car and rolling over in bed. Who knows what would’ve happened if she’d been offered other treatment options.

It’s possible, for example, that Claire could’ve got relief from SCS. Similar to a cardiac pacemaker, SCS involves placing electrodes inside your body near the spine to deliver low levels of electrical energy to the surrounding nerves. You can then use a remote control to block the pain messages being sent from the spinal nerves to the brain by using gentle electrical pulses that mimic the body’s natural signals.

Innovative solutions to pain management have come a long way in the past few years, including a new type of SCS that uses so-called “burst technology”. Whereas the older versions send a single electrical pulse to block pain signals, this new one sends two different types. One is fired in a regular pattern, while the other is faster and sent in rapid-fire bursts, just like a person’s nervous system does. Doctors believe the bursts control pain better and make it possible for people to avoid a sometimes uncomfortable tingling sensation down the leg that can happen with the older-style stimulators. Using burst technology alongside traditional SCS also allows doctors to tailor therapies to patients’ unique pain condition.

This Is MedTech caught up with Cake’s author, Patrick Tobin, to get his take on the technology. “In my research prior to the film, and in the many conversations and emails I’ve had with chronic pain patients since it came out, I’ve come to believe that the science for treating chronic pain is astonishingly limited. Especially given how many people suffer from it ‒ 100 million in the US alone,” says Patrick, whose screenplay was inspired by a devastating family tragedy. “For most people, masking pain with opioids is of diminishing value (addiction being just one problem). To have a device that wasn’t a drug designed to mask symptoms would be a major breakthrough ‒ that it could be initiated at the discretion of the patient seems almost miraculous,” he adds, while also acknowledging that “it sounds like the philosophy and technology has changed rapidly” since he carried out his research for Cake, which was first published as a short story in 2008.

“When Jennifer agreed to do the movie, she did a lot of research. Her stunt double suffered from chronic pain for many years after a boating accident, so that was a big resource,” says Patrick. Jennifer also talked to doctors and patients with chronic pain. In one interview, she comments that there was so much she didn’t understand before her research, but she learned that those with chronic pain often suffer in silence, with people not really believing them or not thinking it’s as serious as it is.

There’s a particularly poignant scene in the film where a woman in Claire’s pain support group says her dream was to make a birthday cake from scratch for her son. Though being a mum can often be physically demanding, most would probably agree that baking a birthday cake is the least of their challenges. But that’s exactly the point: for people enduring chronic pain, even this simple task can seem insurmountable.

Patrick also believes that “most people with chronic pain have experienced suspicion from their [health care] providers about the severity/reality of their pain. Especially in America, where pain medications have become part of the War On Drugs. Because pain evaluation is based on subjective information, I think it’s easy for providers to think that their patients are exaggerating their symptoms and their severity.”

As for why patients might not be aware of SCS or other new treatments, the Cake author says “it seems like a lot of chronic pain sufferers are being treated by their primary physicians and/or specialists involved in the root cause of their chronic pain (e.g. Multiple Sclerosis). I don’t think a lot of patients are being treated by a specialist in chronic pain management, and so I think a lot of cutting edge therapy/treatment options aren’t part of the discussion because they aren’t mainstream yet. And when you’re suffering from chronic pain, I think your ability to do your own research is physically and mentally limited.”

Getting information from other pain sufferers may also be difficult, says Patrick. “I’m not sure how connected chronic pain patients are to other patients – one young man in Los Angeles who reached out to me said he had read the script before it went into production and was excited to find a support group, but discovered it was difficult to find one that met consistently – and this is Los Angeles, the second biggest city in the US. I have friends with HIV who have found that support groups are an important way to find out about new treatments. Maybe it’s hard to develop that same kind of communal exchange of information about chronic pain because it’s difficult for patients to find the energy and motivation to organize and meet on a regular basis?”

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