| One-Minute Clinician

Looking to the Future of Analgesics

For the last decade or longer, we’ve been talking about the challenges with opioids, and they are a challenging class of drug.  On the one hand, they’re great at treating severe levels of pain; they may be the only class of medicine that works for severe pain.  But there’s a lot of baggage associated with opioids, side effects including opioid-induced nausea and vomiting, opioid-induced constipation, opioid-induced endocrine changes, opioid-induced hyperalgesia. Each and every day, I have patients who say “but why are you stopping my medicines” or “why won’t my doctor write these medicines” or “I don’t understand why I have to lower my doses.”  To tell you the truth, I don’t have a good answer other than the landscape that there are certain people who are predisposed to abuse and misuse and there are unintentional deaths related to this class of medication.  But what we failed to recognize is that it’s a completely separate population than the patients that we’re trying to treat.  To rob patients of a therapeutic class of medicine which is effective because there’s another population who are abusing the medicine is a travesty.  And patients really are going to suffer until the time comes that we have analgesics that are effective with a tolerable side effect profile.

But there are non-opioid molecules in development; there’s a lot of excitement around the nerve growth factor class of drug.  Not just for one type of pain but for multiple types of pain, including osteoarthritis, neuropathic pain, low back pain, even other areas outside of pain. There are non-opioid molecules that are anti-inflammatory.  We’ve learned about some of the biologics for rheumatoid arthritis and Crohn’s disease; there may be some biologics that are useful for pain.  And there are newer opioids or opioid-like molecules which can selectively provide analgesia without the respiratory depression, without some of the side effects. So yes, we’re in a tough time right now but the cavalry is on the way.  We have newer medicines coming.  We have effective therapeutic agents that we can look towards the future.  Is that future 2 years or 20 years?  I don’t know, but in the timeline of man it’s not long until we have novel therapies that work for pain.

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