A New Direction in Chronic Pain Management

Pharmaceutical companies that emphasis pain medications as one of their core areas of research continually expend enormous amounts of their research and development budget on trying to find new and unique pain medications.  Some of these companies go so far as to merge with their competition when their companies may advance in this endeavor. Others acquire other small companies to accomplish this same goal.

One of the major problems with pain management is patient compliance. Often a pain medication, prescribed by a patient's pain management healthcare provider, is a perfect choice if the patient would be more compliant with the pain medication administration.  Now, companies such as Millennium out of San Diego, California are working hard to demonstrate patient compliance, or lack thereof, by testing the patient's urine for the metabolites of a given pain medication.  Each class of pain medication differs upon where, in the chain of physiologic reactions, does the medication act.

Currently, the most used pain medications are NSAIDs and opioids. The side effects of these two medications include: nausea and vomiting, gastrointestinal bleeding and ulceration, renal toxicity, constipation, cardiovascular events and hepatotoxicity.

There are three companies that have conducted studies of anti-nerve growth factor drugs (anti-NGF), that treat chronic pain: Pfizer was in a phase III clinical study of its drug Tanezumab at the time that this article was originally drafted.  Since then Pfizer completed this study. Jansen also developed an anti-NGF pain medication they call Fulranumab.  Regeneron Pharmaceuticals currently is completing a phase III clinical research study developing REGN472, its anti-NGF pain medication.

These three companies all agree that there is a signal linking the use of anti-NGF drugs with the deterioration of the joints.  However, they say it's caused by patients that are found to use anti-NGF drugs at the same time as taking   nonsteroidal anti-inflammatory drugs (NSAIDs). Currently, the recommendation that is written in an obvious fashion in the information insert, is that it is contraindicated for the drug to be used along with a NSAID.

Nerve Growth Factor works by blocking a protein that causes an increased sensitivity to pain.

As an accomplished physician and diplomat in pain management (DAAPM) and as a chronic pain management patient, I know the time has come for the development of a new class of pain medication with a much better side-effect profile. I feel that the opinions of healthcare providers who are, coincidentally, chronic pain management patients, should be given much more weight than they are currently given to them.