Editor's Memo
by Forest A. Tennant, MD, DrPH
 Neurogenesis is
simply the growth of nerves. While acute pain may be the result of an offending stimulus
to healthy nerves, chronic pain invariably results from some nerve dysfunction or
“damage.” Nerve repair or regrowth must therefore occur if cure, resolution, or
amelioration is to permanently happen. Surprisingly, the term for this process,
“neurogenesis,” hasn’t yet entered the lexicon of pain treatment. I
don’t recall the term ever being used in a paper submitted to this journal nor do I
recall it being used in any of the many research abstracts I’ve reviewed at the
numerous pain conferences I’ve attended in recent years.
To date, the concept and term ‘neurogenesis’ has remained the purview of a
handful of dedicated animal and bench scientists. This must change. Why? Contrary to the
antiquated belief that damaged nerves, including brain tissue, can’t regenerate,
regrow, or otherwise undergo neurogenesis, it’s happening every day in every pain
practice in the country. Just recall your own conversations and observations of chronic
pain patients. Look at how many no longer have constant pain but now have a few pain free
days or hours. Every physician now knows of some chronic pain patients who have so reduced
their pain levels that they have totally stopped opioid drugs. Look at the incredible
number of pain patients who are progressively improving their quality of life because
their pain has permanently reduced in severity. Folks, this is neurogenesis at its best!
Early research has now clearly identified nerve tissue lesions in chronic pain states.1
While investigations involving nerve tissue defects and neurogenesis are just beginning,
it is rather axiomatic that adequate pain control may not only prevent nerve tissue
lesions but pain treatment—including pharmacologic agents—may act as a
“splint” that allows nerve tissue to regenerate. Treatment agents, such
serotonergic antidepressants in animal research, may even stimulate neurogenesis.
What’s now needed is an understanding of the mechanism of neurogenesis. Clearly,
the current standard chronic pain treatment modalities of medication, exercise,
psychotherapy, hormone replacement, and dietary supplementation aren’t just
symptomatic relief. Neurogenesis must be occurring. Physicians everywhere are getting
results that indicate organic, physiologic changes have taken place. A lot of the new
physiologic techniques, including low level laser and electrical stimulation, may prove to
greatly enhance neurogenesis.
This, however, does not invalidate the original prescription of opioids when the
patient does get better. It’s amazing, for example, how many patients are told they
didn’t really need opioids or muscle relaxants in the first place since their pain
reduced over time. The fact may be that the patient’s medication and symptom relief
may have allowed a suppressed immune system to gear up and promote neurogenesis. It may
well be that current concerns over opioid overuse is really related to neurogenesis. After
all, a regrown bunch of nerves and receptors may not need the same amount of opioid today
that they did a few months ago. In fact, a bunch of regenerated nerves might just
adversely react to a former higher dosage of medication.
The bottom line here is straightforward. We should clearly enunciate for public and
patient that our first goal of chronic pain treatment is to provide immediate humanitarian
relief of suffering, but the long-term goal is neurogenesis. While the term neurogenesis
may initially be a little tough to pronounce for non-medical persons, patients will gladly
master it. After all, neurogenesis is truly the word of hope for millions of chronic pain
sufferers.
—Forest A. Tennant, MD, DrPH
Editor in Chief
1. Kruit MC, Van Buchem MA, Hofman PAM, et al.
Migraine as a Risk Factor for Subclinical Brain Lesions. JAMA. 2004. 291:427-434.
— Nov/Dec 2006
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