haha sorry I missed the point with the RA comments!You are...

haha sorry I missed the point with the RA comments!

You are absolutely right that almost all caues of pain arise from an acute problem, in the case of back pain it is usually and injury but there are a lot of triggers. What isn't well understood is why some people go on to develop chronic pain after the majority of people get better - especially those with normal imaging. I work very closely with patients with chronic pain and it comes in all forms but (save for a few minor sporting injuries) thankfully don't have the first hand that you have.

Acute pain serves a purpose, it allows us to rapidly remove ourselves or body parts from situations which cause tissue damage. Chronic pain is a different beast though, it serves no physiological purpose. There are a number of models proposed for how and why this happens but the premise is that our nerves, spinal cord and brain aren't in a fixed state - more likely they have plasticity in the way that pain is transmitted. Peripheral nerves become more sensitive and generate a response more easily, that signal has less attenuation at the level of the spinal cord and at the level of the brain causes many sequelae - such as avoiding triggers (such as sport or hobbies) which might be a key aspect to maintaining a persons wellbeing. The result of constantly being in pain and missing out on things that you enjoy is loneliness, low mood and isolation which exacerbates the cycle. In fact people with preexisting depressive disorders are at a much higher risk of developing chronic pain, and adequately treating depression with medication and/or psychology improves it. Exercise means gaining function and getting back to (or hopefully close to) a normal life. I am very happy that MSB have included functional measures in the trial for this reason, I think it is just as an important measure as pain severity.

One example of chronic pain is the small percentage of people who sustain minor injuries and go on to develop chronic regional pain syndrome (CRPS). Over the distribution of a small area these people lose muscle and hair, have abnormal sweating and develop chronic pain which is extreme with only the lightest touch. I can only imagine how terrible that must be.

I don't mean to say that there is no ongoing injury in any or all people who have chronic pain, just as I don't think that people with acute injuries should be denied strong pain killers - in fact good early pain control reduces the risk of developing chronic pain. I am just pointing out that medical management (which includes MSC treatment, steroid injections etc) is just one component of a good treatment plan for anyone with chronic pain.

The back pain trial is what first made me buy shares in MSB, I am hopeful that this company will provide a very effective (and marketable) treatment for back pain. I agree that localised long lasting anti-inflammatory cells are highly likely to reduce pain. For the above reasons though I am not expecting any miraculus cure - unfortunately I have learned that treating pain is much more complicated than treating its cause. With that said a modest improvement in pain and function is a massive deal and something to be applauded.