When pain really is in your head

People have been trying to relieve the misery of pain for a very long time. Opium use in Egypt was recorded by 1300 B.C., as was the use of coca plant leaves in pre-Inca cultures. Zaps from electric fish were used to treat headaches and arthritis in antiquity. The first reference to acupuncture in a Chinese medical text was in 300 B.C.  

Many centuries later, scientists are still laboring to treat chronic pain, with limited success. That stalemate leaves patients and doctors feeling helpless.  

As we report in this issue, researchers are now getting a better handle on the complexities of chronic pain, including the brain’s role in amplifying or maintaining pain, and people’s perceptions. As freelance science journalist Cassandra Willyard reports, scientists are pursuing possibilities ranging from new medications to a tiny injectable electrode to forms of cognitive behavioral therapy designed to help patients grasp that chronic pain is sometimes a misfiring signal from the brain that can be managed. Rather than one-size-fits-all, these treatments will be tailored to the patient, and will likely include multiple treatments to better address the complexities of chronic pain. 

Even as our options for medicines evolve, the changing climate may affect their safety. For instance, some medications can make it harder for people to deal with extreme heat. Research suggests that people taking antipsychotics or cardiovascular drugs are more likely to be hospitalized for heat-related illness, staff writer Erin Garcia de Jesús reports. I was intrigued to learn that blood thinners and beta blockers, two very common heart medications, can reduce the amount of blood in the skin that otherwise helps people cool off. That’s no reason to stop taking the meds, the scientists say. But it’s good to keep the risks in mind, especially after another summer when temperatures hit record highs.  

Access to treatments for infectious disease is perhaps an even more urgent challenge. The virus formerly known as monkeypox is once again causing a global health emergency, affecting people in at least 12 African countries. A new variant of mpox may be fueling the spread. There are vaccines and treatments, senior writer Tina Hesman Saey reports, but these drugs are not available in many countries. 

And finally, a story of getting crocodiles to take their medicine: Freshwater crocs in Australia are being trained to avoid eating poisonous cane toads. The toads are an invasive species, introduced by people in the 1930s to combat sugarcane pests. Evidently the toads are tempting snacks. As the amphibians have made their way across the continent, freshwater crocodile populations have plummeted.  

Enter humans. Conservation scientists collaborated with an Australian Indigenous group who see freshwater crocs as important players in their dreamtime stories. The team collected dead cane toads, removed the toxin and replaced it with lithium chloride, which prompts nausea. Crocodiles that dined on nauseating toads were much less likely to eat the live, deadly versions.  

In Aboriginal art and stories, the crocodiles symbolize strength, stealth and survival instincts. And now humans are helping these revered beings learn a new survival skill.