Greater insight into basic biology of pain will reveal non-addictive … – Medical Xpress

March 9, 2017 Credit: CC0 Public Domain

The U.S. medical community needs a better understanding of the biology of pain and how it plays out in individuals to be able to combat the national epidemic of addiction to painkillers, according to researchers from the Perelman School of Medicine at the University of Pennsylvania, in Science this week.

Specifically, they call for a shift in emphasis in drug development towards understanding how people differ in their response to pain medications to develop more precise, safer, and less addictive treatments. "Pain is a syndrome that is poorly understood and research on pain is poorly resourced relative to its prevalence and cost, especially in terms of shattered lives and lost productivity," writes Tilo Grosser, MD, an associate professor of Pharmacology, and Garret A. FitzGerald, MD, FRS, director of the Institute for Translational Medicine and Therapeutics at Penn, along with Clifford J. Woolf, from the Boston Children's Hospital and Harvard Medical School. This plan is especially urgent given no analgesic drugs directed at novel targets have been approved in the past five years.

The authors reason that the opioid epidemic has attained the scale of the HIV/AIDS epidemic at its peak in the mid-1990s, and that a massive and diversified effort by multiple stakeholders is necessary to address the rash of painkiller overdoses: "Encouragingly, this broad-based strategy worked, converting the inevitable lethality of AIDS to a reasonably well controlled, chronic disease."

They propose a bold plan for how to pay for this new research: A substantial investment by the pharmaceutical industry and government to form a public-private partnership to create a $10 billion research fund administered by the National Institutes of Health to complement the $1 billion allocated for combating the opioid epidemic in the 21st Century Cures Act.

They identify interventions in three areas: a better understanding of pain physiology, drug development, and individual variability in response to pain. First, new investigations could address ways to manipulate thresholds of pain and distort pain perception, the difference between inflammatory pain and neuropathic pain, the heritability of pain perception, and the transition from acute to chronic pain. They also cite sex and aging as influences on the perception of pain and the relationship between sleep and pain as areas ripe for research.

With regard to developing new medications, emerging drug targets to control pain include many types of ion channels that transverse cell membranes, cell-surface receptors, and inflammatory molecules. They also mention a need to understand the placebo response as well as such complementary approaches to pain management as acupuncture, yoga, cognitive behavioral and mindfulness techniques, and meditation.

The authors assert that to gain insight into the individual response to pain, researchers need to identify biomarkers to measure drug efficacy, the risk of adverse effects, and to inform the design of clinical trials. "For example, crowdsourcing approaches or electronic health records linked to biobanks can be used to characterize the frequency of the diverse subphenotypes of pains," they wrote.

Explore further: Foot pain often occurs in clusters

More information: "Time for nonaddictive relief of pain," Science (2017). DOI: 10.1126/science.aan0088

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Cannabis is a quite potent pain reliever with fewer side effects than opium derivatives ..

Smoking weed is not a viable alternative. Addiction can be cured without withdrawal symptoms by a single dose of 250mg of healthy adult male facial skin surface lipid pheromone taken by mouth. The collected pheromone is a behavioral biohazard, since it emits "zenite gas"--a subset of its 735 chemicals possessed of pheromonal stereochemistry. This airborne emission, this "zenite gas" causes stupidity, arrogance, incompetence, stubbornness, and suspicion. To mitigate the effects of "zenite gas", the collected pheromone must be packaged with activated charcoal dunnage in airtight packaging and kept under a fume hood. People handling the pheromone should wear supplied air respirators. Administration of the pheromone to patients should be done under oscillating fans at high speed to break up plumes into sub-behavior-threashod concentrations. (This will work like oscillating fans do for SIDS nurseries, although the axillary pheromone of the worried female is the source for SIDS poison

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