Ending chronic pain with new drug therapy?

[Alchemica]

Ending chronic pain with new drug therapy

A brain region controlling whether we feel happy or sad, as well as addiction, is remodeled by chronic pain, reports a new Northwestern Medicine study.

And in a significant breakthrough for the millions of Americans suffering from chronic pain, scientists have developed a new treatment strategy that restores this region and dramatically lessens pain symptoms in an animal model.

The new treatment combines two FDA-approved drugs: a Parkinson's drug, L-dopa, and a non-steroidal anti-inflammatory drug. The combined drugs target brain circuits in the nucleus accumbens and completely eliminate chronic pain behavior when administered to rodents with chronic pain. The key is administering the drugs together and shortly after an injury.

As a result of the study's findings, the scientists are pursuing a clinical trial. The treatment has the potential to prevent chronic pain if used early enough after injury, the scientists said.

The study will be published December 21 in Nature Neuroscience.

"It was surprising to us that chronic pain actually rewires the part of the brain controlling whether you feel happy or sad," said corresponding author D. James Surmeier, chair of physiology at Northwestern University Feinberg School of Medicine. "By understanding what was causing these changes, we were able to design a corrective therapy that worked remarkably well in the models. The question now is whether it will work in humans."

"The study shows you can think of chronic pain as the brain getting addicted to pain," said A. Vania Apkarian, also a corresponding author and a professor of physiology at Feinberg. "The brain circuit that has to do with addiction has gotten involved in the pain process itself."

A group of neurons thought to be responsible for negative emotions became hyper-excitable and more strongly connected with other regions of the brain linked to feeling bad within days after an injury that triggers chronic pain behavior, the study showed. It went on to show this change was triggered by a drop in dopamine, a critical neurotransmitter.

When scientists administered the non-steroidal anti-inflammatory drug and L-dopa, which raises dopamine levels, the changes in the brain were reversed and the animals' chronic pain behavior stopped.

"These results establish chronic pain cannot be viewed as a purely sensory phenomenon but instead is closely related to emotions," Apkarian said.

In addition, Northwestern scientists treated rats experiencing chronic pain with another Parkinson's drug, pramipexole, that activated dopamine receptors, mimicking dopamine's effect. This drug also decreased the animals' pain-like behavior.

"It is remarkable that by changing the activity of a single cell type in an emotional area of the brain, we can prevent the pain behavior," said Marco Martina, associate professor of physiology at Feinberg and also a corresponding author.

Currently, the most common treatment for chronic pain is a non-steroidal anti-inflammatory type of drug, which has limited effectiveness.

"The treatments for chronic pain we currently have are very limited," said Surmeier, also the Nathan Smith Davis Professor of Physiology.

The results of the study suggest supplementing anti-inflammatories with a medication that activates dopamine receptors or raises dopamine levels might be more effective in treating chronic pain and/or preventing a transition to chronic pain.

Chronic pain is an intractable problem for millions of Americans. It's the number one cause of disability in the U.S. and costs more than $600 billion per year in in health care.

An estimated 20 percent of the U.S. and world population suffers from chronic pain, reports the World Health Organization and the National Academy of Sciences.

[courage]

I have chronic pain myself, was only recently diagnosed and haven't looked too deeply into it. Interesting article. I can attest to the syndrome being psychosomatic, but can have a purely physical relation at times. From my own experience I think opiods and addiction are also a contributer, and the two may still be mutually exclusive. Is a very strange disorder.

[Sallubrious]

"It was surprising to us that chronic pain actually rewires the part of the brain controlling whether you feel happy or sad,"

 

It's surprising to me that anyone could not understand that intuitively. Anyone in pain long term tends to be crabby and there's even clichés we all use referring to it.

Bear with a sore tooth etc.

This seems to me like the researchers have switched the definition of cause and effect with some clever sleight of hand.

"By understanding what was causing these changes, we were able to design a corrective therapy that worked remarkably well in the models. The question now is whether it will work in humans."

So with reversed cause-effect theory they designed a way to suppress the effect with a dangerous psychoactive drug with a list of side effects as long your arm and portray it as a causative mechanism.

L dopa often creates many side effects which are commonly treated with other drugs, the same with NSAIDS

They don't say if the psychoactive drugs (L dopa) have to be taken forever, or if it's a cure (which let's face it, it never is these days). What are the long term effects of a drug that increases dopamine levels, the brain becomes dependent and then relies on that drug as it stops making it's own in adequate levels.

It seems like a great way to sell a lot more drugs and not cure the real cause of the pain.

Sorry Alchemica I'm not aiming this at you, I just don't trust researchers that try to find ways to get people on more drugs and ignore the root of the problem at the same time.

[Change]

I tried L Dopa as a nootropic for a few weeks, and like most nootropics i honestly couldn't notice the difference with or without it

[courage]

I don't want to hijack the thread, but I was wondering what people's thoughts on suboxone for chronic pain were. Given the nature of this article it's concerning that mainstream medications treatment may worsen the condition over periods of time?

[migraineur]

I don't want to hijack the thread, but I was wondering what people's thoughts on suboxone for chronic pain were. Given the nature of this article it's concerning that mainstream medications treatment may worsen the condition over periods of time?

I haven't heard of this but I'm going to look into it. One thing to remember is that not all pain is the same so there are different treatments for different kinds of pain. Furthermore, what works for one person might not work for another.

Something that you might be interested in is low dose naltrexone. Although it's an opioid antagonist low doses of naltrexone can have paradoxical analgesic effects. Moreover, it can reduce (or perhaps reverse) opioid induced hyperalgesia and allodynia.

There are numerous other drugs that one can try for chronic pain. There are the anti convulsants such as pregabalin and gabapentin. These drugs may also help with sleep and anxiety etc. Then there are the various anti depressants that one can use for pain. Tricyclic anti depressants such as amitriptyline and nortriptyline are used for neuropathic pain and migraines as well as depression, anxiety, ADHD and numerous other maladies.

Other anti depressants which have analgesic properties are the SNRIs such as Duloxetine and Venlafaxine. There's also Bupropion which can help with nerve pain and is another anti depressant. However, it is similar in structure to cathinones and substituted phenethylamines which probably explains why it's helpful in treating ADHD.

In addition there are opioids, cannabinoids, benzodiazepines, NSAIDs, Botox, steroids, nerve blocks, pulsed radio frequency therapies, spinal cord stimulators, ketamine, mindfulness meditation, exercise and a multitude of other treatments depending on what kind of pain issue you're dealing with.

[courage]

Thanks migraineur, I appreciate your response. I can relate to a lot of what this article is saying, it sheds a bit of light into what's going on with my body/mind. My main fear is as the article touched on, and what I can gather from my own experiences. That through associating physical injury with mood and disrupting the addiction brain circuit by using/abusing addictive pain relief medication the brain just becomes more addicted to pain itself and begins sending out even more signals to the related nerves. Another aspect of this is related to mood and unfortunately in life certain situations just bring you down - then exacerbating pain and interestingly enough with me also psychotic symptoms. This is why I was considering suboxone as it is used to treat addiction and helps with mood. I'd just hate to get stuck on the drug for a period of time only to find when reduced my pain receptors are even more stuffed.

Naltrexone interests me, I did not know it could have analgesic effects as an antagonist. CBD is also something I'm looking into, interestingly THC exacerbates my pain. Serotonin reuptake inhibitors don't sit well with me for a number of reasons and anti-inflammatories have no effect. Spinal injections or pulse therapies etc. may be something I need to try, but again I would need to do some more research. And yes meditation, exercise and good company are all great ways for managing my pain as they not only help with my mood which helps with my addiction but they also assist in releasing energy blockages in the subtle bodies which I have no doubt are intrinsically linked to my condition.

Edited December 23, 2015 by courageoftheweak

[migraineur]

I think what you were trying to talk about in the first paragraph isn't addiction to pain but what's called "central sensitisation" or "central pain syndrome". This is where mindfulness and meditation can come in handy. Check these links for more info:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268359/

https://en.wikipedia.org/wiki/Central_pain_syndrome

Yeah, I was surprised by the information on low dose naltrexone. This might be of great value to you, especially if your body has become addicted to opioids. Also, you shouldn't feel bad about taking opioids for pain if you're prescribed them for legitimate reasons. They are good tools when it comes to treating pain, however, the downside is the side effects.

Which anti depressants (and other meds) have you tried for chronic pain so far and what kind of pain and injury do you have?

I highly recommend getting a nerve block and pulsed RF. If you have private health insurance then it might be fully covered and it's only a day procedure. You go into hospital in the morning, the docs knock you out and do what they have to do and then you wake up groggy and get someone to take you home. Private health insurance might also cover a spinal cord stimulator which can help you get off or reduce medication intake.

I had a nerve block and pulsed RF some months ago and I had a lot of pain relief. I thought it didn't work at first but after a few days or a week I noticed a lot of my nerve pain had gone. I also noticed that my mental health was better because I wasn't in so much pain. I was able to have a big night out with friends and not be worried and anxious about the pain I was in. I could stand and walk for long periods and it was great. Alas, it's worn off but I'm going to get it done again.

By the way, do you see a pain specialist or any other docs for your chronic pain?

[courage]

Yep I understand how sensitisation works and that makes sense. It just seems addiction and prolonged pain meds have a hand in this which is what worries me as I don't want to catalyse this process again. I'll talk to my doctor about naltrexone when he gets back after Christmas break.

I've tried a couple of SSRIs and zyban which had no effect on pain levels and to be honest my mood feels better now that I'm not on them. Lyrica can work wonders for me at higher doses but it only reduces pain if I'm continually lying down. If I get up and wash the dishes or try cook a meal (in other words use the muscles in pain), it will flare up as normal. I've used a good assortment of prescription opiates which generally work, but I have an addiction issue and always end up abusing them so I've been avoiding them as much as I can do.

The injury arose from working non stop on a checkout for close to 5 years. I had to quit my job because of the pain, they tried putting me in different areas but even simply standing would bring on the pain. I also did quite a bit of skateboarding during this time and in the past, I imagine jumping down 10 stairs repeatedly for a few hours didn't do me any good either. With all the adrenalin and hypomanic energy I barely noticed at the time whereas checkout work shitted me and the pain would get unbearable.

Yeah that would be amazing to be able to walk, stand, sit etc. without pain and manage to get on with my life and function properly. I'll have to look into nerve block/pulsed RF treatment more thoroughly. I have only recently started seeing a pain specialist where I got my diagnosis. Nothing shows up on scans or tests so I've almost given up on doctors and just done what I could to cope. After seeing the specialist however I'm more hopeful about sorting it out so will have to approach my GP again. Currently it is my psychiatrist treating me and he's been brilliant, he referred me to the pain specialist and suggested suboxone.

Thanks so much for sharing some of your knowledge and experience with me, it's appreciated.

Edited December 23, 2015 by courageoftheweak

[Sallubrious]

Have you ever looked into myofascial release techniques courage ?

Myofascial adhesions can impinge nerves and muscle tissue and they don't show up on scans as trapped nerves.

Sometimes a simple adhesion in a critical point can can cause all sorts of referred pain and if you know how it's easy to break them down to restore function and alleviate pain.

I'm not suggesting to ignore your doctors advice, but sometimes there are things you can do to help as well.

[courage]

I haven't, but doing a quick google it sounds up my alley. Have you tried it yourself Sally?

"that this soft tissue can become restricted due to psychogenic disease, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow.[1]"

https://en.m.wikipedia.org/wiki/Myofascial_release

Although meditation can be strenuous on my nervous system. Getting into a natural state of empty mind creates a significant release of pain amongst other things and even re-aligns my posture etc. This is how powerful healing the subtle bodies can be.

Edited December 26, 2015 by courageoftheweak

[Sallubrious]

Yeah I do it myself all the time to myself and to other people.

I originally learned how to do it when my Mrs was working with race horses. I saw a guy doing it to a horse and he gave a bit of run down on it. He was getting some remarkable results and restoring lame horses to full functionality.

After a horse has had it done and knows what it's all about, most times the horse will indicate what area needs work by touching it with its nose. For areas the horse can't reach you have to probe around and feel where the areas of tension are.

You can do it yourself, there's youtube vids showing how it's done. When you get a feel for it you can actually feel the adhesions release and it can be like a miracle cure sometimes.

[Scarecrow]

I'm skeptical of the article in the original post because they've conflated "central sensitization" with "chronic pain". It's very typical of articles about journal research to completely miss the point or exaggerate the results. I tried looking for the original research but had difficulty turning anything up without its title mentioned anywhere.

I've tried low dose naltrexone personally for my fibromyalgia to no effect.

Very gentle massage helps for me, but anything more than that worsens my fatigue. Myofascial release for me is too strong of a treatment, and ends up creating more pain than it relieves... although it loosens things up and helps with mobility.

Naltrexone interests me, I did not know it could have analgesic effects as an antagonist. CBD is also something I'm looking into, interestingly THC exacerbates my pain. Serotonin reuptake inhibitors don't sit well with me for a number of reasons and anti-inflammatories have no effect. Spinal injections or pulse therapies etc. may be something I need to try, but again I would need to do some more research. And yes meditation, exercise and good company are all great ways for managing my pain as they not only help with my mood which helps with my addiction but they also assist in releasing energy blockages in the subtle bodies which I have no doubt are intrinsically linked to my condition.

I'm pretty much in the same boat as you here regarding THC and SSRIs. And NSAIDs do more harm than good. Meditation and gentle exercise seem to provide modest temporary relief.

I do have a suspicion that my deeply buried underlying grievances with the direction the modern world is moving in has something to do with my condition...

Actually, it's worth mentioning that the only thing that has provided me complete pain relief for any amount of time is MDMA. I suppose that at such times not only was I able to be at peace with the world, but my brain was also filled with serotonin. I don't fully understand the actions of that particular substance, though. What other implications might this have?

[courage]

Scarecrow I think you hit the nail on the head regarding your grievances. MDMA is gaining a lot of momentum for PTSD treatment, so that would be my first guess. You also mentioned meditation is beneficial which in my experience allows us access to a diverse healing potential for our subtle and energetic bodies, this is where trauma is commonly stored. This is my understanding of my own condition. It's also worth mentioning I watched a video that said triggering myofascial points can commonly elicit pain in another area of the body which isn't necessarily a bad thing, it's just the bodies way of restoring equilibrium and is very common with any genuine healing. A metaphor may be the process of throwing up, it's got to come up and come out before the body gains relief, worth considering.

[Scarecrow]

In my experience trigger points are more useful for concentrated problem localized to specific regions, like sports injuries or tension knots from repetitive overuse of a muscle group. Myofascial release and trigger point therapy are kind of like the heavy artillery of massage. I find having my generalized tension smoothed out a bit with gentle massage is more productive and effective than going at it with such aggressive techniques.

Edited December 26, 2015 by Scarecrow

[Sallubrious]

Yeah Scarecrow I find a lot of trigger point therapists are very aggressive with their approach to myofascial release. When I first read about trigger point therapy it didn't seem anything like the techniques I learned from the guy who was working with horses. I think most trigger point therapists just don't fully understand how the fascial system works and reduce it all to adhesions or cross links which is only part of the bigger picture.

Many good massage therapists have a better understanding of how to gently release tension without taking the aggressive route like a trigger point therapist.

John Barnes is one of the worlds leaders in myofascial release and he uses a much different approach to a trigger point therapist. He gets into the whole mind body spirit type of approach which a lot of people don't like but he gets great results.

His approach is much more like what I'd learned from a horse therapist years ago. Rather than just focusing on adhesions he takes an approach where he tries to re-establish the fluidity of the entire structure and surrounding structures. He also believes emotional trauma can be stored in the body as muscular tension.

 

[Sallubrious]

One more for the road, sorry to derail your thread Alchemica.

I just don't agree with compartmentalised treatments, this guy tries to see the big picture.

 

[courage]

So I just put two tennis balls in a sock and tied a knot.

I lay on the floor and aligned each ball with the muscle on either sides of my spine

When I found a tense spot I just lay still without moving with the balls pushing in on the tense muscular spot. Did this for 5-15 minutes depending

Works wonders! I've been sitting here doing this for a few hours Relieved a bunch of tension and freed up my posture, which is a lot of built up stress. It even relieved some of my psychotic symptoms I assume due to the relaxation and emotional connection

I can see the concept - holding the stretched muscle releases it. They do the same thing in yin yoga!

It's similar to acupressure when you think about it, and imo would be affecting the meridian channels

Thanks Sally for sharing this channel on self-treatement:

https://www.youtube.com/channel/UCKKY9RKj-mGkRF0D0YQoLlg

edit: I'd say I pushed things too hard yesterday. For a gentle approach probably better to do 2-3 points for 5 minute holds and work from there.

But yeah I only worked on my back and can feel the affects throughout all of my body, a 'holistic' approach indeed

Edited December 29, 2015 by courageoftheweak

[sagiXsagi]

Pregabalin is amazing in pain management. I have a 7mm herniated disc slip. Its also reported to be effective in bad cases of chronic pain, mainly of neuropathetic nature. As an analgesic its amazing. Not to mention other uses like in epilepsy and generalised / chronic anxiety among them.

There are side-effects though

Memory problems, sedation, loss of coordination are all commonly reported as negative effects. Most of it fades as the body is getting used.

There is also potential for abuse as one of the possible sideeffects is euphoria and in chronic cases there are tolerance and addiction issues to be considered.

Plus its not so cheap if your health care doesnt cover it or most of it.

Edited January 1, 2016 by sagiXsagi