Every day we experience some type of pain stimulus. While very unpleasant in some cases, this is an adaptive mechanism. Prolonged pain, however, can be maladaptive. Pain ranges from subtle to extreme and acute to chronic. Modern medicine has taken an advantage of pain pathways to develop therapeutic agents.
Non-steroidal anti-inflammatory drugs (NSAIDs) are
typically the first line of defense.
They operate by reversibly inhibiting the cyclooxygenase enzyme subtypes
that ultimately lead to inflammation (Ogbru 2013). The exception to this rule is Aspirin which
does this irreversibly. In addition to
NSAIDs, there are opioid agonists who take an advantage of opioid receptors
(mu, kappa, and delta) (European College of
Neuropsychopharmacology 2007).
They prove effective for pain relief but carry a high risk of addiction
and significant side effects. In fact,
that is the problem with today’s medicine.
There is a high rate of addiction to pain killers which can lead to
overdosing and death.
Research has been looking into manipulating different
pain pathways to develop safer therapies.
Current research efforts have looked into the effects of adenosine and
the A3 adenosine receptor (A3AR) (Little et al. 2014). Pain was alleviated, across a large spectrum,
by increasing the amount of adenosine through inhibition of the adenosine
kinase (Little et al. 2014).
Furthermore, an A3AR agonist developed by the NIH was administered and
provided significant pain relief and reduced pain like behaviors in mice (Little
et al. 2014). Current A3AR agonists are
doing quite well in clinical trials and have demonstrated that they are reasonably
safe thus far (Saint Louis University Medical
Center 2014).
Developing new targets for pain reliefs is wonderful
and will provide great benefits in the future.
The question is this: are we truly addressing the addiction issue or are
we just giving patients something else to potentially get addicted to? In addition to developing safer pain relief
options, it would be great to educate people on the different ways to manage
pain and continue education about the risks of taking pain medicine over a
prolonged period of time.
References:
European College of
Neuropsychopharmacology. 2007. How Does The Opioid System Control Pain, Reward
And Addictive Behavior? ScienceDaily [Internet]. [cited on 2014 Nov 30]. Available from: www.sciencedaily.com/releases/2007/10/071014163647.htm
Little JW
Ogbru, O. 2013. Nonsteroidal Antiinflammatory Drugs.
MedicineNet.com. [Internet]. [cited on
2014 Nov 30]. Available from: http://www.medicinenet.com/nonsteroidal_antiinflammatory_drugs/article.htm
Saint Louis University Medical Center.
Nov 2014. "'Off switch' for pain discovered: Activating the adenosine A3
receptor subtype is key to powerful pain relief." ScienceDaily [Internet]. [cited on 2014 Nov 30]. Available from: www.sciencedaily.com/releases/2014/11/141126132639.htm
Shalacia, thank you for bringing up the topic of pain relievers and addiction. I worked for a pain rehabilitation clinic and saw many patients who were addicted to pain killers and were still in a great amount of pain. As future health care providers, I believe that it is an important topic to discuss as we must balance the costs and benefits of prescribing pain medications.
ReplyDeleteA new medical device, called P-STIM, is an electrical stimulation device that is placed behind the ear and is used to treat pain. The device has no side effects and it is not addictive as it does not use medication. P-STIM works through electrical pulses via needles into selected positions. The company claims that electrical stimulation causes endogenous opoid release as well as inflammatory control. While this device is used for more severe type pain, such as post-surgery or chronic low back pain, it is a safe alternative treatment that can be used. More research is needed to display the effectiveness of the device as many insurance companies will not pay for this procedure.
While P-STIM may not be the right device for pain control, it is interesting to see treatments that are becoming available that may reduce addiction while improving quality of life.
Sources: http://www.biegler.com/pstim.en.html