Overlap in Pathophysiology Suggests New Approaches to Acute Pain May Transfer to Relief from Chronic Pain: A Closer Look

Following the approval of the novel nonopioid NaV1.8 channel blocker suzetrigine for moderate-to-severe acute pain, Patient Care© spent some time discussing perioperative pain management strategy with Edward Mariano, MD, MAS, professor and vice chair in the department of anesthesiology, perioperative and pain medicine at Stanford University School of Medicine in Stanford, CA. In the video above Mariano talks about the danger of poorly managed acute pain transitioning to a chronic condition and how the suzetrigine mechanism of action would function in the latter situation.

The following transcript has been edited for clarity and length

I think they can. We know from a preventative standpoint that extensive research has been conducted to identify risk factors for developing chronic pain, particularly after surgery. Many of my colleagues and I have explored this area, investigating genetic influences, patient characteristics, and perioperative factors that may contribute to chronic pain development. While predictive models have been developed, they are not yet perfect. However, one well-established risk factor is poorly managed acute pain—severe pain that goes untreated, disrupts sleep, and limits activity significantly increases the likelihood of chronic pain development.

Having additional pain management interventions that work alongside existing approaches for acute pain is crucial in preventing chronic pain. Some mechanisms of acute pain management may indeed translate to chronic pain treatment. The biopsychosocial model of pain provides a framework for understanding this crossover, particularly in cases where chronic pain may stem from overactive nerve transmission or signal processing.

For example, suzetrigine has attracted interest due to its role in reducing nerve transmission. This suggests that certain chronic pain conditions, which may result from heightened neural activity, could be responsive to similar therapeutic strategies. Suzetrigine is also currently under investigation for chronic pain conditions, including painful diabetic neuropathy and lumbosacral radiculopathy. These conditions share nerve transmission dysregulation as an underlying mechanism, which is also a key factor in acute pain. This commonality supports the idea that some acute pain management strategies could be applicable to chronic pain treatment as well.

Edward R Mariano, MD, MAS, is a professor and vice chair in the department of anesthesiology, perioperative and pain medicine at Stanford University School of Medicine in Stanford, CA and chief of anesthesiology and perioperative care service at the Veterans Affairs Palo Alto Health Care System. Mariano pioneered the use of continuous peripheral nerve blocks for individuals having same-day surgery. He has worked on key national health care initiatives in the US including accreditation of regional anesthesiology and acute pain medicine fellowships, pain management guidelines, and hospital-based standards.