Opinion

Pain Patients are Craving Booster Therapies.

Pain is complicated. Current treatments are inefficient or highly addictive. It’s time to encourage novel and safe therapies.

That day was the worst pain I ever experienced. I fell brutally on my shoulder and broke my collarbone. For any movements or vibrations, my brain sent a reminder that something was wrong. It was its way to say, please don’t move, you are going to make it worst.

I’m telling you, it is a pretty good functioning system. I did not want to move at all. The pain was so intense. I even became more conscious about the effect of the earth’s gravity on my body.

Over the following weeks, I couldn’t perform any basic daily tasks without feeling pain. Dressing up and showering were off the table.

The ER doctors prescribed Oxycodone(r), an opioid derivative. It was pretty effective.

The decision was obvious, knowing the risk of opioid addiction. So I decided to replace this opiate with acetaminophen, a milder pain reliever that is not good for your liver but good enough to lower the pain, and, at least, it won’t get you hooked up to it for the rest of your life.

Opioids Crisis

According to the CDC, in 2016, about twenty percent of American adults had chronic pain, and eight percent had high-impact chronic pain — meaning pain that limited at least one significant life activity.

Additionally, in 2019, an estimated 10.1 million people aged 12 or older misused opioids in the past year. Specifically, 9.7 million people misused prescription pain relievers. On a side note, the lockdown in place during the COVID-19 pandemic did worsen the situation.

The situation started in the 90s. Pharmaceutical companies’ claims lead the medical community to believe that patients will not be addicted to opioid painkillers.

Thus, healthcare providers started to prescribe them at higher rates. Decades later, it became clear that misuse of opioid medications could be highly addictive.

In 2017, health agencies noticed an increased amount of death by opioid overdose. More than 47,000 Americans died as a result of an opioid overdose, including prescription opioids.

It is now time to act and solve the opioid crisis. Not as easy of a job, you can imagine. Indeed, victims of opioids need help to heal their addictions.

“Le mal est fait,” or the harm has already been done. We have to fix it. Let’s take the problem by the roots and limit the prescription of opioid pain relievers and control their use. Easier to say than to do, but we have to start somewhere.

What makes the complexity of the task is that there is no replacement for it. For that reason, pain management exhibit limited options.

Combination of Molecules to Reduce Opioid Dose

Researchers are creative. They found out that a trivial molecule like caffeine could help. The concept of adjunctive drugs appeals to health agencies. For example, the synergistic pain-relieving effect of a non-addictive molecule with opiates could reduce opioids dose administration, thus reducing the risk of addiction.

Caffeine

Drug manufacturers commonly use caffeine for this purpose. For example, Excedrin(r) is a combination of acetaminophen and caffeine, Anacin(r) combines aspirin and caffeine, and Hycomine(r) mixes hydrocodone and caffeine. However, these are few examples of medications already on the market.

Caffeine is known for its psychostimulant and fatigue reliever properties. Less known, caffeine help reduce pain as well. The mechanism of action is not fully understood. Yet, when combined with another painkiller such as opiate, we believe that caffeine facilitates absorption of the medication for swift pain relief.

Also, caffeine modulates pain via its non-selective blocker effect on adenosine receptors. Therefore, research focusing on more selective agents could significantly impact positively the field of pain and addiction.

The Complexity of Pain Management

Pain management is not as simple as taking a pill and hoping that it goes away. Pain medications often mask the symptoms and don’t address the cause of that pain.

When you go to the ER for a traumatic accident, nurses and health practitioners will do their best to measure and decrease your pain.

A physician would prescribe a light painkiller to complement your endorphins’ release internally in a perfect world. Everything goes away. In the real world, a return to a healthy state could take more than that.

Low back pain is a good illustration. According to the World Health Organization, a chronic condition affects 60 to 70% of the population in industrialized countries. After taking your recommended milligram of acetaminophen, the chances are that you won’t feel your pain anymore within the next 3hours. However, low back pain is well known to be recurrent.

For two-third of the individuals, it will come back within 12 months after recovery. Why that? Well, by taking painkillers, you are only masking the symptoms. You are not targeting the cause, which, by the way, could be as simple as changing bad habits of positioning while seating. Gaining a little bit of muscle around your spine usually helps as well.

What is your pain?

Pain is a complex condition. Its management is subtle. At different pains, different treatment options. A nociceptive pain, also called non-neuropathic pain, is due to an injury or external factor causing bruises, fractures, arthritis, joint damages.

Neuropathic pain is a type of pain caused by a lesion of the somatosensory nervous system. It is not typically caused by an event or injury. When inflammation, irritation, or compression of the neural tissue disrupt those connections, your body ring the alarm with pain that feels like burning, stabbing, tingling, or pins and needles.

The front line to relieve neuropathic pain is anti-depressant and anticonvulsant acting at calcium channels. The second and third lines are composed of lidocaines and opiates. Interestingly, antidepressants are not well accepted by the patients. Health practitioners turn too easily to opioids.

Alternative Pain Treatments

Opioid use doesn’t need to be the answer for the treatment of chronic pain. The risk of addiction is way too high for that. Alternative treatment should be explored.

Non-opioid treatments include laser, massage, and acupuncture. Importantly, have a conversation with your primary care provider about the best way to manage your pain. Your doctor will inform you about treatment availability.