Easing Pain

There have been quite a few studies lately focusing on pain management, each one with a different approach.

The Telegraph (UK) reported October 10, 2008, on a pain treatment that is eight times stronger than morphine and lasts 14 times longer--up to three days.

A team at the University of North Carolina Chapel Hill School of Medicine have pinpointed the identity of a particular "pain protein" in nerve cells and have found a way of converting it from a substance that causes pain into ones that suppress it.

"This protein has the potential to be a groundbreaking treatment for pain," said lead study author Mark Zylka, assistant professor of cell and molecular physiology at UNC.

The substance, which can be injected, appears to have few side effects and works by neutralising the chemical in the body that causes the brain to feel pain.

The Telegraph reported back in January on another approach to reducing chronic pain.

Prof Hanns Ulrich Zeilhofer and colleagues at the University of Zurich identified a target, which is found in a part of the grey matter of the spinal cord, called the dorsal horn, where signals from pain nerves are relayed to the brain.

The protein receives signals from a messenger chemical, called GABA, which is found throughout the nervous system and inhibits signals. In chronic pain sufferers, these signals decline in the dorsal horn and, as a result, the pain continues.

To restore the signals, Prof Zeilhofer and his team used drugs to target one class of the so called GABA-A receptor. They found that by activating this target produces "pronounced analgesia" without unwanted sedation and without paralysis. Nor did mice build up a tolerance to treatment, unlike with many drugs.

The Telegraph also reported back in January on a gene-therapy approach to pain management.

Now a method to use gene therapy - a gene transplant - to simulate the pain relief effects of morphine and other opiate drugs has been developed by a team in the Department of Medicine and Department of Neurosciences at Mount Sinai School of Medicine, New York.

His team designed a virus that could carry a pain relief gene called prepro-beta-endorphin into nerve cells. The gene makes an opioid that the body itself produces and that acts like morphine.

The modified viruses were tested by injecting them directly into the spinal fluid of rats via a lumbar puncture, or spinal tap, with only one injection. Results showed that the rats remained symptom-free for over three months.

Another pain relief gene, interleukin-10, was also effective when similarly administered in small doses directly at the spine.

"One of the strengths of our gene therapy work is, that it was effective with an opioid gene and with a non-opioid gene," says Prof Beutler. "Both approaches have important implications."

And just in case you want something a little more natural, The Telegraph reported October 3, 2008, on a "magic bullet" pain-relief technique.

Childbirth, surgery and trips to the dentist might be less traumatic in the future, thanks to a team at Massachusetts General Hospital and Harvard Medical School, Boston, which has achieved the feat in the laboratory by adding spice to an anaesthetic that by itself should not work because it does not get into nerves.

The sense of pain was selectively switched off in rat hindpaws by injecting QX-314, a normally inactive derivative of the commonly used local anaesthetic lignocaine, and capsaicin, the heat generating ingredient in chilli peppers.

In combination, these chemicals targeted only pain-sensing nerve cells, preventing them from sending signals to the brain. But even though the rats could not feel pain in their paws, they continued to move normally and react to touch.

Why am I focused on pain relief? Am I in pain? No. My mom has some pain since her recent ankle surgery, but it's not the kind of chronic pain these studies are trying to alleviate.

I'm concerned about the push in society for legalizing physician-assisted suicide. The arguments usually include the desire for people to be able to stop their suffering when it becomes unbearable. Morphine can alleviate pain, but the side effects from continuous use are troublesome.

With pain treatments like the ones highlighted by the Telegraph, we can see the time coming not too far down the road when chronic pain may no longer be a factor in the life decisions we have to make. And that can reduce the call for euthanasia and physician-assisted suicide. Any treatments that can help prolong life--rather than unnaturally cut it short--are the kinds of medical advances I want to highlight.

May these research teams be well-funded long enough to get their treatments to the market.