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.