NEW YORKThe next decade will bring advances in pain management as a
direct result of research currently making its way from bench to bedside, said
pain management expert Russell K. Portenoy, MD.
Researchers are elucidating the pathological changes in normal physiology
that eventuate in chronic pain, and are evaluating new ways to modulate those
changes using a variety of new and existing agents, according to Dr. Portenoy,
chairman of the Department of Pain Medicine and Palliative Care, Beth Israel
Medical Center, New York.
"When I got into the pain field, we basically had opioids,
anti-inflammatory drugs, and maybe two adjuvant analgesics," Dr. Portenoy
said at a media briefing held by the American Medical Association. "This
adjuvant analgesic group now has about 70 different medications, and in the
next 10 years, there will be an explosion of new agents coming on the
It is now recognized that a variety of available agents, including
anticonvulsants, antiarrhythmics, antispasmodics, and most antidepressants,
have pain-killing properties. In cancer patients, for example, antidepressants
can ameliorate pain even if there is no evidence of a comorbid depressive
disorder, Dr. Portenoy said.
Likewise, COX-2-specific inhibitors have revolutionized anti-inflammatory
therapy, and botulinum toxin, brought on the market to treat problems with
abnormal muscle tone, is now being used to treat headache, neck pain, and lower
Research is also suggesting that cannabinoid agents will be useful as
analgesics. Other promising agents include nitric oxide inhibitors, N-methyl-D-asparate (NMDA) receptor antagonists, and
compounds that interact with gamma-amino butyric acid (GABA) receptors.
"All of these drugs are being developed, and at least some of them are
likely to appear on the market within the next few years, greatly expanding
even further this extraordinary armamentarium of pharmacologic agents for
chronic pain," Dr. Portenoy said.
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