In late June, a report in Bloomberg Businessweek highlighted the work of researchers at Centrexion, whose work includes trying to develop non-opioid analgesics based on capsaicin (the “hot” chemical in pepper plants). While the focus of the Bloomberg article was on the potential value of such non-opioid treatments, the article also brought attention to an eye-opening piece of information, with regard to pain-treatment research. Quoting Michael Oshinsky, program director for pain and migraine at the National Institutes of Health, the article stated, “The pharma industry has struggled to come up with alternatives. No fewer than 33 experimental medicines for chronic pain went into clinical trials from 2009 to 2013, and all failed.”
Those of us who work in the pain-management community would greatly prefer to prescribe medications that did not hold the potential for respiratory depression, or hormone suppression, or mood-altering effects. However, thus far, the non-opioid medications we prescribe for pain have their own share of potential problems which we cannot overlook (e.g.. renal failure and gastrointestinal bleeding from NSAIDs, liver failure from acetaminophen, cognitive impairment with anticonvulsants, etc.). We have a responsibility to prescribe what we believe to be the most likely effective, safest, treatment for each patient at a given point in time. That safety profile changes over time, which is why we cannot simply “set it and forget it” with regard to medical management, and why ongoing re-evaluation is critical.
Here and now, 2016, we have the hindsight of roughly 30 years of availability of sustained-release opioids. Before that, everyone in the healthcare community knew morphine, fentanyl, oxycodone, etc. could alleviate pain for a few hours after each dose. Pharma began marketing sustained-release versions of the medications to try to provide that relief for more than just those couple of hours at a time. The healthcare community now seems to understand that opioids have a more limited utility than they were touted to have in the late 1990s/early 2000s. However, one fact remains: Opioids are prescribed for pain because they actually work, for many patients, better than anything else.
