Pain and Hunger: A Surprising Analogy for Chronic Pain Management

Analogy Time

Recently, the FDA approved a new pain reliever called Journavx. For you scientifically inclined nerds, it was designed by Vertex Pharmaceuticals for the treatment of moderate to severe acute pain. Some of the studies I’ve read indicate that over 80% of the patients studied reported good to excellent pain relief after surgical and nonsurgical procedures. Just as importantly, the relief lasts for an extended period, whereas a patient might get only 4 to 6 hours of relief from a dose of Oxycontin by contrast. More research is needed on the risk of patients becoming addicted to Journavx, but initial results show the risk to be small. There is a catch, of course. Initial reports indicate that this new drug would cost patients $30 a day, which is considered expensive by both patients and insurance companies (yes, these two groups can agree on something), so access to it will be an issue. As a chronic pain patient who uses opioids as part of my pain management (with "part" being the key word), I see this as a great development. When it comes to the treatment of all pain, the more options, the better.

While reading about Journavx on social media, I came across a post from a pharmaceutical group stating that this development would be “a major leap forward in reducing prolonged opioid use and transforming pain management.” On the surface, this statement presents as positive. Traditionally, pain management has not been the “it” or “sexy” issue in medicine, so it doesn’t get the same research exposure as, say, cancer. Of course, anything that could potentially lower the number of opioid-related complications is a positive. That said, I quickly became offended by the statement because my use of opioids is not prolonged by my choice, as is being implied by this group. My use of opioids is straightforward: my pain is prolonged, so I need a treatment plan that matches its duration.

As a good advocate should, I used the announcement of Journavx and my dislike of the word “prolonged” as an opportunity to write a lengthy blog, using my life as a pain patient as a reference point. I talked about the difference between acute and chronic pain, the importance of understanding time, the different types of pain, and how language can cause so much stigma, further limiting access. Although I thought I rambled on in several spots, I was generally happy with the six pages I ended up creating.

Funny Story

About 15 seconds after declaring the post finished, I had an epiphany. Pain shares many similarities with hunger. For example, hunger is both an acute and chronic condition, just like pain. In this analogy, opioids are like eating three meals a day. Steroid injections, trigger point injections, and radiofrequency ablations are like eating out at a fancy restaurant or at grandma’s house. Even working out, going to the gym, hiking, spending time with family and friends, reading, or creating art fits into this analogy. These activities are akin to physical or occupational therapy, cognitive behavioral therapy, or any other mental health counseling related to pain.

Some of you might be wondering if I have fallen off another cliff or was involved in another car accident. It’s a fair question, which I promise I have not. I honestly believe I’m onto something here, so I humbly ask that you hear me out before making a judgment on my mental capabilities. With that request in mind, let’s dive into the details of this idea.

I’m Hungry…Again and Again and Again—Just Like Pain

We all experience hunger on some level. Hunger is our body's way of telling us that it wants and needs fuel, which we receive from food. It occurs on both an acute and chronic level. Food ends our hunger for the moment while providing our bodies with the necessary energy and stamina to continue with life. Like life, this is a never-ending process. We can’t just eat one meal and never need to eat again. If we don’t get food to satisfy our hunger, our bodies instinctively begin to conserve energy by shutting down nonessential functions.

Pain shares many qualities with hunger. To begin with, we all experience pain on some level as part of our human experience. It can be as simple as stubbing our toes on a piece of furniture or as complex as rheumatoid arthritis. Like hunger, it can occur on both an acute and chronic level. Instead of alerting us to a need for fuel, pain is our body’s way of letting us know that something is wrong. If we don’t treat our pain, our bodies can also instinctively begin to shut down to have enough energy to combat whatever is wrong with us. Our bodies are amazing.

Perhaps the most important similarity between hunger and pain is that neither has a permanent cure. Yes, eating a meal cures hunger at that moment, but hunger will return again and again if we don’t continue to eat. Pain is the same way. Yes, an opioid or steroid injection might cure my pain in that moment, but my pain will return because the conditions I have causing said pain don’t have a permanent cure. Pain and hunger are both conditions that the best we can hope for is constant management.

Food and Opioids

For this analogy, I’m going to use the traditional understanding of humans needing three meals a day to control hunger. I know this is somewhat of an antiquated idea, but it is a standard we are familiar with.

At this point, I’d like to clarify the meaning of acute and chronic. In simple terms, acute pain has a time limit of 60 to 90 days, depending on who you ask. Chronic pain is any pain that lasts longer than 90 days. Common types of acute pain include a sprained ankle, recovering from surgery, or a broken arm. Types of chronic pain include rheumatoid arthritis, cancer pain, or migraines.

Much like hunger, my pain is considered chronic because I’ll be dealing with it for the rest of my life (yikes, that was depressing to write). Obviously, hunger is a lifelong problem too. That said, eating meals, like utilizing opioids, is considered an acute treatment. Both address the now—the pain or hunger of a particular moment—not the lifelong struggle.

Treatments like steroid injections, trigger point injections, radiofrequency ablations, or even off-label medications like Gabapentin are akin to dining out for a special occasion—or simply because it’s Thursday and you don’t feel like cooking. They are also considered acute treatments for chronic pain. While these are safe and effective pain management options, they are often cost-prohibitive and can’t be used regularly (even with great insurance).

Movement Is Medicine

Although going to the gym, hiking, or any kind of movement only indirectly fits into my food analogy, I’m including these activities because chronic pain patients are often told to "just work out more" or "lose more weight." Setting aside the fact that many of us avoid these activities due to overwhelming pain, movement is medicine when done correctly.

Regular exercise helps us process food more efficiently, whether through better digestion or fueling our bodies for activity. Similarly, engaging in physical activity can support pain management over time, much like counseling supports mental health.

Conclusion

I’ll be the first to admit my analogy isn’t perfect—no analogy ever is. I understand that food is necessary for survival, whereas opioids are not. In fact, I’ll go one step further and say that my use of opioids as a pain management tool is a personal choice, not a necessity like food.

That said, I like this analogy because my relationship with pain is very similar to our relationship with food and hunger. Hopefully, this helps make my life as a chronic pain patient easier to understand.

If Journavx proves to be excellent for chronic pain management, I’ll be the first to request a trial—assuming I can afford it. Until then, I’ll continue to utilize and advocate for treatments that best match my prolonged pain, hunger, and quest for a better quality of life.