Persistent pain is thought to affect as many as 28 million Britons (Image: Getty)
The latest science suggests that a different form of AI — analgesic intelligence — could be the solution to the persistent pain problems which plague as many as 28 million people in the UK. Because brain scans and neural mapping show that our minds really do matter when it comes to pain control, and that failing to get on top of pain can lead to permanent changes in our brain and pain pathways.
But the good news is that this emerging science around the way that our brains respond to pain also points to new strategies and approaches which could provide better pain relief with fewer side effects. Dr Nisa Aslam, a GP and advisor to Combogesic, a new over-the-counter, opioid-free pain relief medicine with a unique and clinically proven combination of 500mg paracetamol and 150mg ibuprofen, says: “Pain is one of the most common problems we see in general practice and it has a huge impact on a patient’s overall wellbeing and quality of life.
“It’s very exciting to see how new research is improving our understanding of pain pathways and paving the way for a more joined-up approach to pain management. It will also help us to unpick the recognised link between pain and low mood, and find new ways to use this knowledge to improve symptom relief.”
Not all pain is the same
Dr Nisa Aslam says new research is improving our understanding of pain (Image: Courtesy Nisa Aslam)
Doctors have always drawn a distinction between short-term, or acute, pain and more persistent and prolonged discomfort, which is often described as chronic pain. Acute pain often acts as a signal to seek help because something is wrong, or we have been injured, while chronic pain can linger long after the initial injury has healed.
Now scientists at Stanford University have discovered that acute and chronic pain are activated by different neural pathways. Professor Xiaoke Chen, says, “A surprise to us was that acute pain and chronic pain can be completely separate. There is a dedicated circuit that only activates after injury.” Using this discovery alongside genetics and mapping via neurons tagged with fluorescent proteins, Professor Chen and his team discovered a second circuit which drives chronic pain and makes the brain hypersensitive to even a gentle touch.
Placebo power and mind mapping
If we believe something will ease pain, it does. A 2025 study at Manchester University is the latest in a long line of research which confirms the power of placebo — symptom relief based on an expectation that something will work.
A mix of 237 patients with osteoarthritis, fibromyalgia and no pain problems were split into two groups. Half were told a local anaesthetic cream would be applied to their forearm and half that they would get an inactive active cream, and they were then asked to rank a uniform level of pain from a laser. This was repeated two weeks later, to verify the results — and in both cases, there was a “significant reduction in pain in the placebo group”.
Another team at Sydney University used powerful functional MRI scans to chart a built-in brain map in our brains which suggests that pain relief from a placebo appears to be linked to cannabinoid receptors. Lead author, Dr Lewis Crawford, says: “The brain’s natural pain relief system is more nuanced than we thought. We now have a blueprint for how the brain controls pain in a spatially organised way. This could help us design more effective and personalised treatments, especially for people with chronic pain in a specific area of their body.”
Dr Nisa Aslam says: “We should never underestimate the power of positivity, and non-drug interventions such as exercise, mindfulness and psychological therapies which can be used alongside analgesia.”
Combogesic is a new over-the-counter pain medication (Image: AFT)
Pain relieved
The latest research shows that combining proven painkillers in a specific 3.3:1 ratio of paracetamol to ibuprofen provides optimal pain relief with none of the gastric safety risks associated with higher doses of ibuprofen. “This is a far more intelligent approach to analgesia as it combines two established pain-relief products at a ratio which is clinically proven to amplify their well documented synergistic action,” says Dr Nisa Aslam.
Combogesic is the only product in the UK which utilises this ratio with a unique formulation of 500mg of paracetamol and 150mg of ibuprofen — 50mg less than is found in other combined pain relief medicines. A single dose of Combogesic is clinically proven to be 80% more effective than paracetamol alone and 30% more effective than ibuprofen alone. Combogesic also provides meaningful pain relief 18 minutes faster than ibuprofen on its own. It is available via Boots, Superdrug, independent pharmacies nationwide and Amazon. For more information, visit combogesic.co.uk
Hunger pains
Professor Nicholas Betley, a neuroscientist at the University of Pennsylvania, noticed that our brains prioritise what we need to survive and says that, when it comes to chronic, lingering pain, hunger proved to be a powerful painkiller. Or, as one of his colleagues explains: “If you’re starving or facing a predator, you can’t afford to be overwhelmed by lingering pain.”
Their observations lead to the discovery of specific receptors in the brain which drive chronic pain. Professor Betley says, “What we’re showing is that the problem may not be in the nerves at the site of injury, but in the brain circuit itself. If we can target these neurons, that opens up a whole new path for treatment.” Dr Nisa Aslam says: “It is still very early days, but the hope is that these discoveries could lead to new therapies which help chronic pain becoming established. It also highlights the importance of getting on top of pain before it becomes entrenched.”
Hunger gains
That’s not the only link between pain and hunger. Professor Toby Newton-John (singer Olivia’s half brother) says comfort eating is real and two-thirds of people with chronic pain problems turn to food when they’re in pain. He says: “For many, eating comfort foods provided a nice experience in their day and something to look forward to. If you’re living with pain all the time, that moment of pleasure becomes a pretty powerful motivator.
“There may also be a biological explanation. Research shows high-calorie foods can have a mild pain-relieving effect. It’s possible that there is a real analgesic property to these foods as well.” However Dr Nisa Aslam cautions: “Obesity can exacerbate a lot of musculoskeletal pain as it puts extra pressure on joints and increases systemic inflammation, which can also ramp up pain problems.”
She advises: “As tempting as it might be, this is one coping strategy it’s better to avoid.” Professor Newton-John’s research confirms that almost 40% of the study participants were obese and warns comfort eating “can trap people in a spiral that’s very hard to break”.
Tune in for relief
Just 20 minutes of music will help to relieve pain and depression caused by constant discomfort, a meta-analysis study which combined results from nine randomised trials in 787 patients has shown. The study, published in BMC Psychology last year found music therapy is most effective when patients select their own music, use instruments or earphones, or receive treatment from trained music therapists.
A second study, at McGill University in Canada, discovered that music therapy is even more effective when it mirrors our own natural rhythm — which was assessed by asking patients to tap out Twinkle Twinkle, Little Star.
Perfection pitfall
Last year, researchers at Murdoch University in West Australia discovered that perfectionists report higher levels of pain than patients who cut themselves more slack and lowered their expectations on what they should be doing.
Dr Graeme Ditchburn explains: “Chronic pain sufferers may experience frustration with difficulties performing day-to-day activities and push themselves toward unrealistic or unachievable goals. They may also feel that others have expectations that are difficult to meet.”
He says: “Our findings suggest that interventions aimed at increasing self-compassion and addressing perfectionistic tendencies may be beneficial for individuals experiencing chronic pain.”
