Conquering Pain

Back to feature: The Complex Nature of the Brain

Who? Dr. Yves De Koninck is Professor of Psychiatry and Neuroscience at Laval University, Adjunct Professor of Pharmacology and Therapeutics at McGill University, Director of the Cellular and Molecular Neurosciences Unit at the Institut universitaire en santé mentale de Québec, and Director of the Quebec Pain Research Network.

What’s the issue?
Uncontrolled pain continues to be the single most common cause of disability that impairs the quality of life. Chronic pain affects over 20% of the Canadian population, resulting in enormous socio-economic costs. Many chronic-pain syndromes still are not being treated adequately; complete pain control is rarely achieved, and the incidence of disabling side effects remain a very high.

What's the research?
Our CIHR-funded research seeks to understand what is going wrong in the nervous system when chronic-pain syndromes occur, what makes a normal pain signal become intolerable (hyperalgesia), and why a normally non-painful signal can sometimes trigger highly debilitating abnormal pain (allodynia).

What's the impact?
One of our research findings is that after an injury to a nerve or to the spinal cord, or a peripheral inflammation, or diabetes, or even after extended periods on certain medications, an inflammation process occurs within the spinal cord. This process produces a cascade of events leading to a loss of inhibitory control onto the neurons that relay the pain signal to the brain. This loss of control results from the dysfunction of a protein called KCC2 (Nature, 2003; Nature, 2005; Nature Neuroscience, 2013) and makes the pain-relay neurons react in an erroneous, exaggerated way, producing a signal that the brain abnormally interprets as pain. Our studies have led us to establish a program for systematically discovering and developing new compounds that restore the normal function of KCC2 and thereby re-establish normal inhibitory control in the nervous system. This program has already yielded several potential analgesics that our team is currently studying with the goal of producing new medications for chronic pain.

Our findings support those of several other teams revealing that chronic pain results from a dysfunction of the central nervous system (brain and spinal cord). Thus, chronic pain must be regarded as a disease in itself and be treated as such. This represents a major paradigm shift from the earlier view that pain is only an alarm signal, the consequence of another problem and not a problem on its own. With this realization, which stems from pure research efforts, we are witnessing a transformation in our health-care system, in the way that care is organized, and also in the pharmaceutical industry’s approach to pain. All of these developments can only benefit the patients who are coping with a problem that completely saps their quality of life.

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