The Search for the Killer Painkiller

NY Times ^ | February 15, 2005 | ANDREW POLLACK

[neverdem]

Susan Farley for The New York Times

Joan Klopfer, 54 | Bronx, nurse
I used to be a nurse at Sloan-Kettering Cancer Center. In late 1997, I was lifting a heavy patient in the I.C.U. when I felt pain shooting down both my legs.

I knew right away I was in trouble. I had two herniated disks as a result and had to undergo spinal fusion. I woke up in the recovery room in the most excruciating pain you could imagine. It was worse than natural childbirth. They gave me morphine, which wasn't really enough.

I went home with a prescription for Percocet. It would offer me some relief for maybe an hour, then this awful pain would start again. Eventually, they put me on OxyContin, and I would take oxycodone as a "rescue dose" whenever I experienced terrible breakthrough pain.

Now, seven years later, I'm in constant pain, and this is as good as it's going to be. I'm permanently disabled. I probably will never work again.

My life is altered tremendously as a result of the pain.

Marty Katz for The New York Times
Farrell Fitch, 59 | Chevy Chase, Md., agency worker
I have nerve damage on the left side of my face, a result of shingles. At first, I thought I'd be fine and could get through it. But I couldn't. It feels like a branding iron pressed against my head.

What's discouraging is that you lose faith in the medicine. It takes the edge off the pain, but can never really take it away.

My doctor started me on hydrocodone and an antidepressant. After about two years, I wasn't getting any better so I tried other things. I tried acupuncture, massage therapy, even Chinese herbs. Eventually, I went to a pain specialist and one of the first things he had me do was to try methadone. It was a catastrophe. It just made me incredibly sick.

I got better when I combined Neurontin and Vicodin; something just clicked. Three years later, I had another crushing episode. I had to stop working and go on disability.

The pain is a large part of my life now. I struggle with it.

Frances Roberts for The New York Times

Steve Feldman, 52 | Manhattan, advertising
I was diagnosed with Lyme disease about seven years ago, and a side effect of it is arthritis. It's affected my hips, my hands and my fingers. The only time it bothers me is when the Lyme disease kicks in, which inflames everything.

When it first started, I asked my doctor what I could take besides aspirin or Motrin. All those things really have no effect on it at all.

We tried one of the arthritis medications, Vioxx, and the sides effects were awful. I suffered nausea and stomach pains and stopped taking it.

Then my doctor suggested some nutritional alternatives that had worked for some of his other patients. I said, "Sure, anything to get rid of the aches."

So I started taking glucosamine, fish oils and a product that's an oil made from macadamia nuts. I actually started feeling the aches going away after a couple weeks.

My doctor also said don't stagnate. In other words, walk. Use the joints. That helps me because it gets the muscles and the tendons around the joints used to working.

[neverdem]

FReepmail me if you want on or off my health and science ping list.

[zencat]

I'm with you. Have abnormal large congenital cysts in my C-T region and many more in the L region. Several of the cysts are over 1cm in the T region and cause unimaginable pain and numbness down my arms. Have a pretty good doc that cool with narcotics, but most people can't understand that it's just not "back pain". Duh! You've freaking cysts around the nerve root push on the nerve itself. It doesn't only hurt at times, just an indescribable feelings of numbness, pain. It's still not all about the narcotics, but does help the same way antibiotics help strep throat or pneumonia.

[John Valentine]

The authors failed to mention this one, perhaps the most promising of new therapies for neuropathic pain:

ACV1

Metabolic's novel compound ACV1, was discovered by Associate Professor Bruce Livett and fellow scientists associated with the University of Melbourne. ACV1 is a peptide compound discovered in the venom of the Australian marine cone snail, Conus Victoriae, which has been found to have profound analgesic properties. Owing to the success and advanced stage of efficacy testing already performed on the compound, Metabolic will accelerate the commencement of a pre-clinical toxicity program. Metabolic has acquired from the inventors the exclusive worldwide license to commercialise ACV1, in return for milestone and royalty payments.

Cone snails have evolved a rich cocktail of peptides in their venom, which together act by a variety of mechanisms in the nervous system to quickly immobilize or kill their prey. The potential of cone snail venoms as a source of new therapies has been recognised for many years, and the first such compound to be commercialised is the analgesic Ziconotide being developed by Elan Pharmaceuticals. Ziconotide acts by blocking a component of the central nervous system called the N-type calcium channel and must be injected into the spine (directly into the central nervous system) so as to avoid adverse reductions in blood pressure which would otherwise occur. ACV1 acts by an entirely novel mechanism, specifically blocking a subtype of a broad class of receptors in the peripheral nervous system called neuronal nicotinic acetylcholine receptors (nAChR). Unlike other cone snail venoms, ACV1 is effective and without apparent adverse effects when administered by convenient routes such as subcutaneous injection, providing substantial pain relief in models of nerve pain. Nerve (neuropathic) pain is the category of pain having the greatest need for improved drugs. An additional unique feature is that ACV1 also appears from the animal data to accelerate the functional recovery of injured nerves.

More here: http://www.metabolic.com.au/

[corkoman]

Very good article. The withdrawal of Vioxx and Celeb are forcing all new drugs to be compared with the opiodes. Other than the dependancy issue and constipation they are remarkably well-tolerated for chronic use over decades. Being compared to opiates is unfair - with their high safety profile any new drug is going to have to jump through hoops of fire to get approved.

Pain is nature's fire alarm but the Maker didnt give us a very good way to turn that alarm klaxon off.

[St.Mark]

Sciatica, pain down my right leg all the times. Some days are worse than others. Right now I am on Vicoden but my tolerance for the drug has gone up and so has the pain. It hurts so bad sometimes I cry and I am a 50 year old man that never cried a day in his adult life.

[xJones]

I took my cousin to a chronic pain care center. She has very bad daily migraine headaches and she'd done all the pain meds plus alternative meds, herbals, and acupuncture.

While I waited for her, I talked to the other people and everyone else was there for chronic back pain. I don't what they got, but my cousin had cortisone shots to both sides of her neck. It only eases things for about 3 months. Any migraine help would be appreciated.

[afnamvet]

Having just been released from the hospital for a partial bowel obstruction (Crohn's disease), I can attest to the effectiveness of morphine. 2-4mg every four hours for level 7-8 pain. I don't recall the alternative pain med name that was available.

[Goodgirlinred]

I just want my Viox back until they come up with something just as good to replace it. I had forgotten how bad the pain was until I had to go off of it and it got out of my system. Now I have to take OTC Ibuprophen in high doses and experience stomach upset. :(

[steve86]

Have your tried acupuncture? It stopped my mother's sciatica in its tracks, instantly, after several unproductive visits to conventional physicians. And my wife had the experience of sinus clearing while actually receiving the acupuncture.

I am 50 also and went through the crying thing in the 90s. Embarrassing when you know the neighbors can hear it. My pain left on its own -- so might yours.

[steve86]

Maybe some acupuncturists are better than others.

[John Valentine]

ACV1 is targeted at precisely your type of pain. See above.

Problem is, it's four years away from the market.

[unixfox]

Oh man how I feel your pain! I have sciatica as well and it has to be the worst pain you can get. My leg has gone so numb that I couldn't walk.

I cannot tolerate codeine or any derivative thereof. I have learned to actually pop my back to alleviate the pressure. The problem with painkillers is that they only trick your brain into thinking the pain is gone. When what they should really do is attack the affected area.

[Graybeard58]

Having just been released from the hospital for a partial bowel obstruction

My colon ruptured and the pain was intense. Two years after that surgery, scar tissue obstructed my bowels. THAT pain made the original pain seem like a picnic.

On vacation, lying on a couch in a motel lobby waiting for an ambulance to come through a snow storm. A cop got there before the ambulance and I layed there wondering if I could get his gun some how and end that pain.

I am 59 years old and that was the first and only time I had ever given a thought to suicide.

[St.Mark]

Bear Wash- I hope it does leave like what happened to you. The Doc's say surgery is my only option besides drugs. The success rate stinks with back surgery. I have to apologize for the whining it's hurting bad tonight and I know I won't be able to sleep. Enough said, thanks for listening and understanding, sometimes a man can feel so damn alone with a problem.

[St.Mark]

I wish there was a cure too Unixfox I REALLY do!

[afnamvet]

I am 59 years old and that was the first and only time I had ever given a thought to suicide.

I'm 57 and have had those thoughts countless times. March 15th is the surgery date for either bowel resection (will be my 6th surgery) or multiple stricture plasty. Quality of life isn't too promising but who knows until after this is over. Good health to you and yours.

Roger

[neverdem]

Triptan nonresponder studies: implications for clinical practice.

Birth contol pills can cause migraines. Good luck

[not_apathetic_anymore]

bookmark

[KingNo155]

Did she see a good dentist? I only ask because my brother suffered from migraines for years and Doctors and dentists could not find any reason. To cut it short... he went to a new dentist who found a hairline crack inside his tooth next to the nerve, the tooth was removed and now he no longer has migraines.