Chapter 16 - Mechanism-Based Treatment and Precision Medicine

Abstract

The driving force to advance pain medicine is the continual search for new and innovative solutions to a wide range of chronic pain conditions that affect over 50 million Americans. Mechanism-based and precision pain medicine represents an approach that has the potential for safe, efficacious, and cost-effective care of patients with chronic pain. In this chapter, we review the mechanism-based treatments. We discuss the current treatments that are partially effective for a proportion of patients with appropriate indications and treatments that are under development but show limited success. We highlight the emerging therapies, including cell therapies (mesenchymal stromal cells/stem cells) and blood-derived products (platelet rich plasma and autologous conditioned serum) that have shown long-term benefits with a body of literature support. As the main focus of this chapter, we highlight neuroimmune modulation as a key mechanism of chronic pain and a promising therapeutic target of current treatment (e.g. neuromodulation with spinal cord stimulation and vagus nerve stimulation) and emerging cell therapies and blood-derived products. Notably, specialized pro-resolving mediators (SPMs) exert potent analgesic actions while simultaneously promoting inflammation resolution in pre-clinical studies. SPMs may also serve as a biomarker for chronic pain (associated with decreased SPM production) and a biomarker for effective pain treatment (e.g. neuromodulation associated with increased SPM production). Precision pain medicine based genomic testing and streamlining of relevant polymorphisms of genes encoding receptors, transporters, and drug-metabolizing enzymes influencing the pain phenotype represents a future direction of personalized pain management.