In the mid-1990s prescriptions for pain meds skyrocketed as oxycodone came to market. Chronic pain sufferers were hopeful that this new formula would bring an end to their pain. It worked for some, but not all. What happened instead in many areas was an epidemic of over prescription and a dangerous trend of dependence and overdose. Physicians and healthcare communities responded, recognizing that opioids are not always the best choice for chronic or non-cancer pain. Thankfully, new pain meds and alternate therapies are being developed.

These pain meds hold promise for a safer way to help chronic pain sufferers with fewer side effects.

Pain meds for pain caused by inflammation have in the past had dangerous side effects or proven to be ineffective long-term, but a new medicine is being developed to change that. While looking for the reason behind lower heart attack rates for moderate drinkers, researchers at the Stanford University School of Medicine found that the compound Alda-1 reduced pain related to inflammation in mice and rats. Even better, Alda-1 is not addictive and does not have risks for the heart and gastrointestinal systems that are present with non-steroidal anti-inflammatory drugs (NSAIDs).

Daria Mochly-Rosen, professor of chemical and systems biology and senior author of the paper published in the August 2014 edition of Science Translational Medicine, says that this serendipitous discovery is a breakthrough in pain meds for one important reason:

“Finding a new pain medication is important because we need a safer drug; there are 17,000 deaths from prescription opiate overdoses a year alone.”

It is important to note that Alda-1 did not decrease inflammation. This does not make the compound less valuable, though. Patients can get safe relief from pain while they work with their doctors to treat the underlying causes. They may also feel more comfortable doing physical therapy or exercising because they are pain-free.

The discovery of the effects of Alda-1 on inflammatory pain is not the only “accidental” discovery of a potential pain treatment. Researchers at the University of Nottingham have discovered that vascular endothelial growth factor (VEGF), a signal protein responsible for the re-growth of blood vessels in injured tissues, can actually affect pain signals. VEGF comes in two forms, one which activates blood vessel growth, causing pain, and the other that blocks blood vessel growth. The form that blocks blood vessel growth in injured areas can help prevent pain.

VEGF has been extensively studied as it relates to cancer. New blood vessels growing around a tumor can actually feed the tumor and cause it to grow. More research is needed to determine how these two compounds work, but the discovery that one can prevent pain could result in alternative pain meds that regulate them to control pain without dangerous side effects.

The discussion of serious side effects most often centers on opioids and dependence or overdose, but non-steroidal anti-inflammatory drugs (NSAIDs) have potentially fatal side effects as well. These include heart attack, stroke, and serious gastrointestinal disorders. New studies that target two particular enzymes in the body may lead to promising NSAIDs that either lower or eliminate the risk of heart disease as a side effect.

The first action is suppression of the enzyme COX-2, the same action that NSAIDs perform that causes pain relief. The second action, deleting the enzyme mPGES-1, helps to avoid potential serious side effects. Lihong Chen, MD, PhD, a postdoctoral fellow working in the lab of the Institute for Translational Medicine believes that:

“[t]aken together these studies add more evidence that targeting the enzyme mPEGS-1 could result in a new class of nonsteroidal anti-inflammatory drugs that steer clear of heart-disease risk and even work to reduce it…What is exciting here is the prospect of retaining the benefit of NSAIDs while substituting cardiovascular benefit for risk.”

Not all new discoveries involve pain meds in the traditional sense.

Evidence of the effectiveness of antidepressants to control chronic pain is rising, even when depression is not a factor. The action of antidepressants is not fully understood in the body, but it may work on neurotransmitters to suppress pain signals.

Antidepressants are seen to be most effective on the following types of chronic pain:

  • Arthritis
  • Diabetic neuropathy
  • Postherpetic neuralgia
  • Nerve pain from other causes (peripheral neuropathy, spinal cord injury, stroke, or radiculopathy)
  • Tension headache
  • Migraine
  • Facial pain
  • Fibromyalgia
  • Low back pain
  • Pelvic pain

As when taken for depression, the effects of antidepressants on chronic pain are not immediately felt. Patients may have to take them for several weeks before they begin to feel relief. Tricyclic antidepressants are most commonly prescribed for chronic pain, and they include:

  • Amitriptyline
  • Clomipramine
  • Desipramine
  • Doxepin
  • Imipramine
  • Nortriptyline

These antidepressants are not without side effects. Patients may elect to take other types of antidepressants with fewer side effects. Serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) have side effects but they may not be quite as effective.

A positive side effect of antidepressants may be a mood boost. Chronic pain patients are more likely to suffer from depression, and antidepressants can help treat not only the pain but also the attendant mood disorders.

Sometimes the biggest advances in pain meds have nothing to do with the medicines themselves.

William McKay, M.D., professor of anesthesiology in perioperative medicine and pain management at the University of Saskatchewan, Saskatoon, Canada knows firsthand about the fear of needles. “As many as 1 in 10 people experience needle phobia, which may have negative consequences, such as decreasing the rate of vaccinations and blood donation.” This fear may also prevent people from getting other chronic pain treatments such as steroidal injections.

A study presented at the Anesthesiology 2014 conference revealed that applying vibration to the skin for 20 seconds before an injection significantly reduced the perception of pain. This may be due to distraction, or it may be that the gate-control theory of pain is at work. This theory says that certain sensations such as vibration and pressure close the “gate” that allows pain to register in the brain.

Whether it is a nearly pain-free injection or an enzyme that treats pain without serious side effects, research on pain meds and pain therapies continues to promise more options in chronic pain treatment. Ask your doctor about the latest research.

Image by Keoni Cabral via Flickr

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