Pain meds of the future ??Posted by BrianG on 3/26/03 at 16:50 (114709)
I found this intertesting. I'm happy the researchers are looking into alternatives to narcotics. Until then, I personally believe narcotics make the best pain meds!
Enkephalin Analogs More Potent, Less Addictive Than Morphine
Reuters Health Information 2003. © 2003 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
By Martha Kerr
NEW YORK (Reuters Health) Mar 24 - Glycosylated enkephalins in which a sugar, such as glucose, maltose or maltotriose, is attached to the neuropeptide, has two to three times the potency of morphine without having some of its most addictive properties, researchers reported at the annual meeting of the American Chemical Society in New Orleans on Monday.
Dr. Robin Polt of the University of Arizona at Tucson described how by attaching a simple sugar, these glycosylated enkephalins 'can be rendered permeable to the blood-brain barrier in much the same way as morphine.'
Dr. Polt told Reuters Health that the glycosylated enkephalins 'are very specific in the effects they produce. They are remarkable not in what they do, but what they don't do.'
The results of animal studies indicate that the compounds do not produce the euphoria induced with morphine, but have approximately two to three times the analgesic effect, he said.
'We are analyzing the side effects of glycosylated enkephalins now,' Dr. Polt continued. 'We're looking at their effects on cardiovascular function, respiration, addiction behaviors and so on. We plan to test these effects in rhesus monkeys and pigs next. The results will be emerging in the next year or two. Those findings will be critical to launching clinical studies.'
Glycosylated enkephalins bind to both pain receptors in the brain, mu and delta, while morphine binds only to the mu receptor, Dr. Polt said. This would explain the boosted analgesic effect of these compounds.
'This could be the first 'non-narcotic narcotic,' but we'll need to do more work before we can say that.'
'The mechanism of transport is what is important about this research,' Dr. Polt said. 'This carbohydrate approach could be applied to prolactin, for example, and induce positive effects on memory.' There are hundreds of peptides that this approach could be adapted to, the Tucson researcher added
Re: Pain meds of the future ??john h on 3/26/03 at 18:47 (114712)
Brian: Did you get to see my post on the social board about the use of drugs such as oxycodone and fentanyl? Mayo says their studies indicate if used under a doctors control they may be better than living in pain. I made the complete post but the board is down for theological maintenance for 3 days.
Re: Pain meds of the future ??Dr. Z on 3/26/03 at 19:11 (114718)
Fentanyl is an excellent pain medication for chronic pain managment. It comes in the form of a patch.
Re: Pain meds of the future ??BrianG on 3/26/03 at 21:11 (114725)
I've missed a few posts lately, but if it were not for pain meds, my life would be worth shi* !!!
Re: Pain meds of the future ??Sharon W on 3/27/03 at 08:03 (114748)
I was hoping to see that! Is there any way you could re-post it here (please)? It would certainly be appropriate for a board on treating PF...
Re: Pain meds of the future ??john h on 3/27/03 at 09:40 (114752)
Sharon: I am at the office now and it is at home. I should have posted it on this board. I will repost tonight. As I said Mayo studies indicate that some opioid drugs can be safely used to treat chronic pain. Only about 2-10% of people being treated on an ongoing basis might suffer withdrawal symptoms and those can be handled easy enough. They also note your typical family Doctor is reluctant to prescribe these drugs because of a lack of knowledge. Pain specialist are ususally more aware of current studies and will use these drugs. They note that living with long term pain can be much worse than using pain relievers that work and allow you to function. They also mentioned a couple of drugs as ones that are effective but I do not remember their names. Seems one was Fenytal or something similor to that. Another was a drug that sounded similar to oxyocoytin but did not seem to be the same one we are all familiar with. I know Brian keeps up with this stuff and is a believer in keeping your pain under control with drugs if need be. A lot of recent studies indicate Doctors do not aggressively treat pain.
Re: Pain meds of the future ??john h on 3/27/03 at 10:12 (114759)
Brian two of the drugs mentioned in the Mayo study for treatment of long term pain were (Fentanyl also known as Duragesic) and Oxycodone known by the more common name of Oxycontin. You might access he http://www.mayoclinc.com and make your way to their pain control site. They publish a monthly newsletter which is very good covering all subjects.
Re: Pain meds of the future ??john h on 3/27/03 at 10:17 (114760)
Dr. Z good point about this med. I did notice it came in patches of different strengths. Some of our posters have really been in chroic pain such as Laurie R and Nancy S at one time. I wonder if their Doctors ever provided them with an effective pain reliever other than your typical NASID? Severe pain sot of creates more pain and it feeds on itself. If you can break the pain cycycle at least for a while it seems you have a better chance addressing the underlying condition.
Re: Pain meds of the future ??Sharon W on 3/27/03 at 10:43 (114761)
THAT'S for sure! My family Dr. will not prescribe anything stronger than Darvocet... if she thinks someone needs more than THAT, she sends them to a pain specialist.
In fact, she was muttering a few months ago about some doctor in another state being successfully sued for not providing adequate pain control for an elderly patient. She thought that was unfair, because the main reason (she said) that she and other doctors avoid prescribing any narcotic pain killers is because there have been so many (successful) lawsuits in the recent years brought by patients who became addicted to painkillers and ultimately ended up going from doctor to doctor looking for pain killer prescriptions, and/or purchasing them on the street. Even though it's pretty much impossible for each new doctor involved in a patient's case to know what OTHER doctors are also prescribing painkillers for them, doctors who were lied to have been successfully sued when the patient became addicted.
I have to admit, my doctor had a point. But MOST patients with chronic are not drug-seeking fiends, we're just people who need (and deserve) some reasonable pain relief... Somehow, we need to find a happy medium in this country, where chronic pain patients get do the pain meds they need but are NOT able to go from doctor to doctor getting more and more of them.
Whew! Sorry to be so long-winded! :'>
I'm looking forward to reading that article, though. Thanks, John.
Re: Pain meds of the future ??john h on 3/27/03 at 11:46 (114765)
forget this URL it is the wrong one.
Re: Pain meds of the future ??BrianG on 3/27/03 at 22:27 (114799)
Almost every state has guidelines for doctors to prescribe narcotics for chronic pain patients. If the doctors follow these guidelines, they should be OK. Me thinks it's time to educate your doc!!!! Just use a search engine, put in 'pain medication guidelines' There were 82 hits on Google.com!!
John, about something that you mentioned earlier in this thread. Everyone who uses narcotics for pain relief, will experience withdrawals, if they suddenly cease to take the meds. Most people who do take them (pain meds) have an agreement with their doctor. It can be written, or verbal. Part of it states that the paptient will only get his pain meds from one doctor. On the doctor's end, he agrees to taper the patient down, when needed. It may take a month, or even longer, but the witdrawal syptoms are greatly reduced with a good taper schedule.
Hey, it's almost spring :*)
Re: Pain meds of the future ??john h on 3/28/03 at 09:17 (114814)
Brian: I have never been on a narcotic for any length of time. With some of the drugs I have taken over an extended period of Time such as Ultram (50 M.G. a day) I would stop for a week just to make sure I had no unexpected results from stopping the drug. The one drug I took on two occasions which was really effective for pain relief was a Medrol Dose Pack. Of course it was one of those drugs you have to be careful with so I only took the two packs. I know a couple of ladies who have bad rheumatoid arthritis who take this drug on a regular basis. More and more you are reading articles that studies indicate the medical community way undertreats pain even after major surgery. .
Re: Pain meds of the future ??Kathy G on 3/29/03 at 09:35 (114872)
The medical community in general is very poor at prescribing pain medication, be it the proper med or the proper dose. Surveys have shown that surgeons (!) are among the worst. Many medical schools have changed their curriculum in an effort to further educate their students on the value of effective pain management.
My brother-in-law had back surgery a couple of years ago and his doctor had never heard of Oxy-Contin! This was prior to all the robberies so it wasn't as well known at the time. He had to study up on it before he prescibed it for my brother-in-law who was on Percocet at the time which was ineffective and made him nauseous. This is a sad commentary.
It seems as though the media does not help because it dwells on the side-effects of narcotic pain relief rather than the fact that these drugs allow people in pain to get on with their lives. It is encouraging that more and more pain management centers are cropping up and more doctors are specializing in the field.
Re: Pain meds of the future ??john h on 3/29/03 at 18:50 (114913)
Kathy: 23 years ago I had low back surgery. Immediately after surgery my surgeon hopped a plane to Hawaii while I was still in the recovery room. When I awakened my back went into spasm in the area of the incision and I thought I would surely die. Since my Doctor was not available no one would give me anything. He also happened to be a friend and when he returned I gave him a really hard time. Now days people should make it clear up front with your surgeon that you want some 'pain control' after surgery if needed. I do not mean aspirin..
Re: Pain meds of the future ??Kathy G on 3/30/03 at 00:52 (114919)
That brings to mind the TV ad that shows a woman who just had a baby and her doctor prescribed Tylenol. I would be less than happy with a doctor who prescribed Tylenol after childbirth!
You're right. Nowadays, one has to discuss pain control prior to surgery.
Re: Pain meds of the future ??BrianG on 3/30/03 at 21:15 (114950)
And don't forget to get it in writing, with a copy for yourself!!!!!! I would have loved to have such a note, when I had my ruptued appendex, was horribly under medicated, and nearly died. I really don't think the nurses, or doctors gave a shi* about my pain! This was about 20 years ago.
Re: Pain meds of the future ??Kathy G on 4/01/03 at 16:27 (115109)
And with the current shortage of nurses, Brian, nowadays even if they care, they probably wouldn't have the time to address the pain issue. Our medical system is rapidly detiorating!
Re: Pain meds of the future ??Sharon W on 4/01/03 at 18:44 (115118)
The way the pain meds thing works in the hospital is as follows: there are often some routine meds that all the doctors have agreed on and that nurses can give to patients whenever they think the patient needs them. These typically include Tylenol, and something for nausea. Beyond that, the individual doctor will usually write one or two prescriptions for pain that are PRN, or 'per need', and the nurse can give these to the patient (within the limits specified by the doctor) when needed, as well. So the nurse does have a lot of discretion.
However, there are some doctors who will not write a routine prescription for pain meds, or will write a prescription for a pain med that's clearly inadequate. And in that case, when the patient is in pain and Tylenol (or whatever) just doesn't do it for them, the nurse has to call or page the doctor of record and ask them for something stronger. This can sometimes be difficult because it can take quite a while for the doctor to respond to the call... And there really is nothing that the nurse can do about it!
Re: Pain meds TODAYBrianG on 4/01/03 at 20:32 (115127)
I was in that hospital for over two weeks, undermedicated the whole time! Not even my family would go to bat for me. I have no doubt that I would be dead, if it wasn't for modern antibiotics. It's one of the reasons I try to help out people in pain, when I can.
To tell you the truth, I think we need more lawsuits against doctors and hospitals for unnecessary pain and suffering. Money talks, and when it leaves their pockets, hopefully they will get up to speed on treating pain issues. The medications are available, the guidelines are in place, now all we need is the man with the 'magic pad' to have some compassion! It's a cop out to say they heard of a friend, of a friend, who got in trouble once, because someone scammed him!!! If that happens, let the police handle it, don't punish everyone else.
OK, off the soap box, for now :*)