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Chronic Pain: New Research, New Treatments

WebMD talks to Scott M. Fishman, MD, president of the American Pain Foundation

Q: What new chronic pain drugs are in the pipeline?

A: I'm very pleased we are coming up with ways to deliver drugs that are less of a burden on patients. There are now several long-acting (also called sustained-release) products that patients don't have to take every three or four hours and be constantly thinking about when to take the next pill.

I'm also excited about new drugs coming out for nerve damage pain. There are all sorts of ion channels in the body we didn't know existed five or 10 years ago but that we are now targeting as potential pain relievers. New drugs aim to target these ion channels, which are involved in moving electrolytes in and out of the nerves to make them fire and send a pain message to the brain. If we can impact that channel, we can stop the nerve from firing. The key is to be able to do it without tripping all the nerves in the body, just those involved in the problem we're trying to treat. But the future is bright, and these drugs are in the pipeline. We'll be seeing some in a few years.

As for drugs already available, many are very useful but we could benefit from using them more wisely. They range from opioids and antidepressants to anticonvulsants and other novel agents. They all have special properties and we're still learning about them; for example, we're still not sure how antidepressants work to help chronic pain.

Q: About pain medication, are doctors being better educated about this in medical school?

A: Pain is the most common reason a patient goes to a doctor, and sadly we train doctors, clinicians, and nurses very little on pain and pain care. We now recognize that we have a public health crisis of undertreated pain, but we also have a public health crisis of prescription drug abuse. Some doctors overprescribe and some feel they [painkilling drugs] should never be prescribed. Frankly, neither of those situations should be allowed to exist and wouldn't exist if doctors were trained up front. They may be better trained today but only marginally so, and we need to bring education back to the medical school and to practicing physicians as well.

Q: Narcotic opioids and other painkillers are in the news, and patients and physicians do grapple with this issue a lot.

A: Right. The bottom line is that opioids can help people but they also can harm people. We do want to use them properly because they can be problematic, including their addictive properties. But many patients fear that any addictive drug taken long enough can make you an addict, and that just isn't true.

The big question is, "What's the proper use?" And how would you know that someone is having a problem with an opioid? The answer is they would not have a good response -- that is, real pain relief. When the intense focus on pain is taken away, their function improves. Contrast that to the patient with an addiction, which is the compulsive use of the drug that produces dysfunction. So if a doctor is watching a patient and treating him or her rationally and safely, that doctor will see that happen and stop the drug.

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