The ironic agonies of pain relief

We keep trying to find ways to make it harder for people to abuse opioids. Perhaps we should be working harder to find new ways to treat intractable pain.

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Of all the many emails and news releases I receive about potential therapeutics, from discovery through clinical trials, what strikes me at times isn’t so much what I see, but what I don’t see.
Sure, there are innumerable announcements and news tidbits about cancer treatments and neurological disorders and many others, but what I don’t see much of is word about pain relief.
Or rather, I don’t see much new on that front.
This was brought home to me this month with an email from Elliot Fox, director of media and engagement for Egalet Corp, which is working to develop treatment alternatives to the commonly abused pain medications currently available. As Fox wrote, “As we all have seen, there is a rise in the abuse of opioid medications, and something needs to be done. Egalet is strategically working to provide a solution by developing an abuse deterrent—or an ‘indestructible’— pill that provides patients suffering with pain a safer treatment option.” Among its products on the market now are Oxaydo tablets for oral use only that are formulated to deter abuse via snorting and Sprix Nasal Spray, a non-steroidal anti-inflammatory drug for short-term management of pain that requires analgesia at the opioid level.
Along with that, a news release in my inbox from Collegium Pharmaceutical Inc. announced FDA approcal of Xtampza ER (oxycodone) extended-release capsules which use the proprietary DETERx technology platform for abuse-deterrence.
These and products like them from other companies are important, I know. Pain is a condition that needs to be managed for the good of patients, and opioids play a necessary role. But why, I wonder, do I see so little of research on new pathways for pain management compared to other therapeutic areas?
There are hints of hope, however, that make me feel I may see more of that in the future. Another email I received recently spoke about presentations by leading scientific experts who will be at Pain Therapeutics 2016, with several exclusive presentations on key evolving therapies, among them updates on the preclinical and clinical development of selective sodium channel blockers, clinical translation success in trials for capsaicin-based remedies and small-molecule Nav1.7 inhibitors, among other things.
For now, the relative dearth of pain relief news continues, but I hope to see a shift soon in my inbox.
By way of awkward transition, let me conclude by telling you about the commentaries in our May 2016 issue and the “pains” they involve—or don’t. For one, DDNews Features editor (and bi-monthly columnist) Randall C Willis speaks of the discomfort of anecdotes vs. evidence, when so often people latch on to highly touted “remedies” in the news and social media feeds that are often more rumor or hype than actual promise. However, even in the anecdotes, he notes, we sometimes find the beginning of wisdom that leads to development and clinical testing of potential therapeutics.
Also, a guest commentary about dealing with the pains of processing massive amounts of information through data visualization.
Finally, something far from pain. Spurred on by my editorial a couple issues ago, titled “A cancer cavalcade for March,” Dr. Joe Olechno, a senior research fellow with LabCyte, sent me a thorough breakdown of an alternative to the personalized medicine model for cancer. I can say it is a genuine pleasure to have provoked such a lengthy response—essentially a commentary in itself. I can’t say I’ve ever received feedback that came complete with lengthy references.
May your reading of this issue be filled with insights and encouragement—and no pain.

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